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Descriptive study of the mobile instructional resource centre project : August 1973 to March 1974 Gobert, Robert Charles 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) W e accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA August, 1977 Cf-) Robert Charles Gobert, 1977  In p r e s e n t i n g t h i s an  thesis  in p a r t i a l  advanced degree at the U n i v e r s i t y of B r i t i s h  the L i b r a r y I  further  for  s h a l l make i t  scholarly  of t h i s  freely  available  It  i s understood that  written permission.  Adult  Education  The U n i v e r s i t y o f B r i t i s h  2075 Wesbrook Place Vancouver, Canada V6T 1W5  a  t  e  August  Columbia, I agree that  copying of this  thesis  purposes may be granted by the Head of my Department or  thesis f o r f i n a n c i a l gain s h a l l  Department o f  for  f o r reference and study.  agree t h a t p e r m i s s i o n f o r e x t e n s i v e  by h i s r e p r e s e n t a t i v e s .  D  f u l f i l m e n t o f the requirements  20th,  1977  Columbia  copying or  publication  not be allowed without my  ABSTRACT The P.A. Woodward Mobile I n s t r u c t i o n a l Resource Project  (MIRC) was a motorized  Centre  e d u c a t i o n a l d e l i v e r y system used  by the D i v i s i o n o f C o n t i n u i n g Education  i n the H e a l t h Sciences a t  the U n i v e r s i t y o f B r i t i s h Columbia t o p r o v i d e l e a r n i n g o p p o r t u n i t i e s f o r h e a l t h p r o f e s s i o n a l s i n t h e i r home communities.  This  study d e s c r i b e s the p r o j e c t and analyzes i t s r o l e i n c o n t i n u i n g education i n the h e a l t h f i e l d  f o r those r e s i d e n t i n the r u r a l  areas  served by the p r o j e c t . The MIRC was a highway bus converted t i n u i n g education f a c i l i t y  i n t o a mobile  c o n t a i n i n g three audio v i s u a l l e a r n i n g  s t a t i o n s and over 1300 audio v i s u a l l e a r n i n g programs. by a graduate  con-  Operated  a d u l t 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 p e r i o d , data were o b t a i n e d from 521 p a r t i c i -  pants  i n 11 h e a l t h p r o f e s s i o n s and from 136 n o n - p a r t i c i p a n t s i n  seven h e a l t h p r o f e s s i o n s . P a r t i c i p a t i o n r a t e s i n the MIRC p r o j e c t were higher  than  those i n other programs p r o v i d e d by the D i v i s i o n o f C o n t i n u i n g Educ a t i o n i n the Health Sciences d u r i n g the same p e r i o d whether examined by community o r by p r o f e s s i o n a l category.  MIRC p a r t i c i p a t i o n  r a t e s were s i g n i f i c a n t l y higher among those p r o f e s s i o n s f o r whom the D i v i s i o n provided other programs than they were among those f o r whom i t d i d not.  P a r t i c i p a t i o n r a t e s were not r e l a t e d t o d i s t a n c e  from Vancouver but were h i g h e r f o r communities w i t h s m a l l e r  local  hospitals. The  MIRC p r o j e c t appears t o have served a d i f f e r e n t s e t  of i n d i v i d u a l s than d i d other D i v i s i o n programs.  Direct  costs  were approximately f o u r times as h i g h but the expenses borne by participants  and t h e i r employers were not c o n s i d e r e d .  Participants with r e s p e c t  and n o n - p a r t i c i p a n t s  t o sex, p r o f e s s i o n ,  ber o f p r o f e s s i o n a l  differed significantly  l o c a t i o n of employment, and num-  books read.  Reactions t o the p r o j e c t , measured on a f i v e - p o i n t were f a v o r a b l e  over-all.  Significant differences  scale,  among the pro-  f e s s i o n a l groups were observed on two items and among v a r i o u s communities on a l l items.  R e a c t i o n scores were not s i g n i f i c a n t l y r e -  l a t e d t o p a r t i c i p a t i o n r a t e s o r to the s i z e o f communities, but were h i g h e r i n communities nearer Vancouver. By a s s i g n i n g  ranks t o e i g h t a l t e r n a t i v e e d u c a t i o n a l de-  l i v e r y systems, the respondents as a whole i n d i c a t e d preferred  an a u d i o - v i s u a l  MIRC p r o j e c t .  learning  that  they  s t a t i o n i n a h o s p i t a l o r i n the  P a r t i c i p a n t s whose rankings were not r e l a t e d to  those o f n o n - p a r t i c i p a n t s participants preferred  preferred  these same two systems.  Non-  u s i n g a h o s p i t a l l i b r a r y or a t t e n d i n g  courses o u t s i d e t h e i r communities. Among the reasons g i v e n f o r not p a r t i c i p a t i n g , most d i d not  suggest ways i n which the p r o j e c t c o u l d  participation.  be a l t e r e d to improve  iv I t was  concluded t h a t the MIRC p r o j e c t i s an a c c e p t a b l e  and e f f e c t i v e system f o r d e l i v e r i n g c o n t i n u i n g  e d u c a t i o n oppor-  t u n i t i e s to h e a l t h p r o f e s s i o n a l s i n r u r a l B r i t i s h  Columbia.  V  TABLE OF CONTENTS Page ABSTRACT  i i  LIST OF TABLES  viii X  LIST OF FIGURES ACKNOWLEDGEMENTS  xi  CHAPTER I  INTRODUCTION  1  PURPOSE OF THE STUDY  3  PROCEDURE  3  DATA COLLECTION  3  DATA ANALYSIS  4  DEFINITION OF TERMS  :  REVIEW OF THE LITERATURE  4 5  HOME STUDY  6  OFF-CAMPUS COURSES  9  MEDIA  12  Mass Media  12  I n s t r u c t i o n a l Media  19  COMMUNITY-INITIATED SYSTEMS  II  .. .  23  D i s c u s s i o n Groups  24  Community-Initiated Courses  26  THE MIRC PROJECT  28  ORIGINS OF THE PROJECT  28  DESCRIPTION OF THE MIRC  29  vi  CHAPTER  Page ADMINISTRATION  30  OPERATION  31  ROLE OF THE FIELD SUPERVISOR  36  SUMMARY III  38  PARTICIPATION AND COMPARISON WITH OTHER CONCURRENT PROGRAMS  39  PARTICIPATION  39  PARTICIPATION BY PROFESSION  40  PARTICIPATION BY LOCATION  43  PARTICIPATION BY HOSPITAL SIZE  44  PARTICIPATION BY COMMUNITY DISTANCE COMPARISON OF PARTICIPATION IN THE  . . . . 47  MIRC WITH OTHER PROGRAMS  49  PARTICIPATION BY PROFESSION  51  PARTICIPATION BY LOCATION  54  COMPARISON OF CLIENTELE  . . . . . 57  COMPARATIVE COSTS SUMMARY . . . . . IV  CHARACTERISTICS OF PARTICIPANTS  6  .  0  64 66  CHARACTERISTICS OF THE POPULATION  66  DEMOGRAPHIC CHARACTERISTICS  67  EMPLOYMENT CHARACTERISTICS  67  CONTINUING EDUCATION ACTIVITIES  68  COMPARISON OF PARTICIPANTS AND NON-PARTICIPANTS DEMOGRAPHIC CHARACTERISTICS  69 69  vii  CHAPTER  Page EMPLOYMENT CHARACTERISTICS  71  CONTINUING  74  REACTIONS  EDUCATION  ACTIVITIES  OF PARTICIPANTS  78  REACTIONS  BY PROFESSION  78  REACTIONS  BY LOCATION  80  RANKINGS OF ALTERNATIVE DELIVERY SYSTEMS  V  85  REASONS FOR NOT PARTICIPATING  88  SUMMARY  90  SUMMARY, CONCLUSIONS AND IMPLICATIONS  93  SUMMARY  93  CONCLUSIONS  98  IMPLICATIONS FOR CONTINUING  BIBLIOGRAPHY  . . .  EDUCATION  99  IMPLICATIONS FOR THE MIRC PROJECT  102  IMPLICATIONS FOR FURTHER STUDY  104  .  107  APPENDICES  114  A  QUESTIONNAIRES  114  B  SPECIFICATIONS FOR VEHICLE AND EQUIPMENT  131  C  ITINERARY  133  D  SCHEDULE  OF OPERATION  135  viii LIST OF TABLES TABLE I II III IV V  VI  VII  VIII  IX  X XI  XII XIII  Page Percentage D i s t r i b u t i o n Of M a t e r i a l s In The MIRC By P r o f e s s i o n And Type o f Program: August 1973 . .  33  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 H e a l t h P r o f e s s i o n a l C a t e g o r i e s  41  Comparison Of Communities By P a r t i c i p a t i o n Rates, P o p u l a t i o n , And Number o f L o c a l H o s p i t a l Beds . . .  45  Comparison o f Communities By P a r t i c i p a t i o n Rates And D i s t a n c e s From Vancouver  48  Percentage D i s t r i b u t i o n o f Enrollment In Courses And Workshops By P r o f e s s i o n And By Residence: August 1, 1973 t o March 31, 1974  50  Comparison Of P a r t i c i p a t i o n Rates In The MIRC P r o j e c t And Other D i v i s i o n Programs Between August 1, 1973 and March 31, 1974  52  Comparison Of P a r t i c i p a t i o n Rates In The MIRC P r o j e c t And In Other D i v i s i o n Programs By H e a l t h P r o f e s s i o n a l s From Communities V i s i t e d By The MIRC By P r o f e s s i o n  55  Comparison Of P a r t i c i p a t i o n Rates In The MIRC P r o j e c t And Other D i v i s i o n Programs By H e a l t h P r o f e s s i o n a l s From Communities V i s i t e d By The MIRC By L o c a t i o n  56  Comparison Of I n d i v i d u a l s P a r t i c i p a t i n g In The MIRC P r o j e c t And Other D i v i s i o n Programs By P a r t i c i p a n t s ' Home Communities .  58  Costs Of Operating The MIRC P r o j e c t August 1, 1973 And March 31, 1974  61  Between  Comparison Of Costs Of The MIRC P r o j e c t And Other D i v i s i o n Programs Between August 1, 197 3 And March 31, 19 74 ~  63  Comparison Of P a r t i c i p a n t s And N o n - P a r t i c i p a n t s On Demographic C h a r a c t e r i s t i c s  VO  Percentage D i s t r i b u t i o n Of P a r t i c i p a n t s And N o n - P a r t i c i p a n t s By P r o f e s s i o n  72  ix Page  TABLE XIV Percentage Distribution Of Participants And Non-Participants By Employment Characteristics ... 73 XV N Po en rcP ea nr tt ag e Distribution OnfuiPnagrtiEcdiupcaanttisonAnd i c i p a n t s B y C o n t i 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 Participants 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 1  X  LIST OF FIGURES FIGURE  Page  1  Layout And Arrangement Of The Mobile I n s t r u c t i o n a l Resource Centre  2  Map Of Communities Included In The MIRC Itinerary: August 1, 1973 To March 31, 1974  3  P a r t i c i p a t i o n Rates By H o s p i t a l S i z e  32 . . .  35 46  xi ACKNOWLEDGEMENTS The  author would l i k e t o express h i s s i n c e r e a p p r e c i a -  t i o n t o a number o f people whose i n v a l u a b l e a s s i s t a n c e made t h i s study p o s s i b l e . In a d u l t education: ing  Dr. C o o l i e Verner, whose  outstand-  c o n t r i b u t i o n s t o the d i s c i p l i n e brought me t o t h i s u n i v e r s i t y ,  who i n t r o d u c e d me to the h e a l t h s c i e n c e s , and whose g e n t l e  persua-  s i o n encouraged me t o "get the damn t h i n g done"; and Dr. John C o l l i n s , who i s able t o i n s p i r e and demand more than seems p o s s i b l e but provides  the support  t o make i t happen.  In the h e a l t h s c i e n c e s : ciousness  and u n f a i l i n g support  Mr. Ralph Barnard, whose g r a -  i n the face o f more than o c c a s i o n a l  a d v e r s i t y were a mainstay d u r i n g the MIRC p r o j e c t ; Dr. H.O. Murphy, whose energy and imagination helped Mrs.  M.S. Neylan, who helped  t o develop the p r o j e c t ;  t o make i t go; Dr. M.F. Williamson and  other members of the D i v i s i o n Committee, whose encouragement and support  d u r i n g the p r e p a r a t i o n o f t h i s manuscript were g r e a t l y  a p p r e c i a t e d ; and Dr. John F. McCreary, whose l e a d e r s h i p and v i s i o n w i l l be a c o n t i n u i n g i n s p i r a t i o n t o us a l l . S p e c i a l thanks t o Vinay  Kanetar f o r h i s a s s i s t a n c e with  computer problems and t o M i l l i Penner and E l a i n e L i a u who somehow made my notes look l i k e a t h e s 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 proliferation 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 deterioration 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 economic 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  i n g and m a i n t a i n i n g tion.  competence i s c o n t i n u i n g p r o f e s s i o n a l educa-  Indeed, four o f the p r o f e s s i o n s :  d e n t i s t r y , medicine,  n u r s i n g and pharmacy have begun t o s p e c i f y t h a t the r i g h t t o p r a c t i c e i s c o n d i t i o n a l on p a r t i c i p a t i o n i n c o n t i n u i n g education (11, 56,68,75).  T h i s i n c r e a s i n g emphasis on c o n t i n u i n g education i s  appropriate  i n an i d e a l sense because o f i t s p o t e n t i a l a b i l i t y t o  provide  the necessary o p p o r t u n i t i e s f o r l i f e l o n g p r o f e s s i o n a l de-  velopment and growth, but there are a number o f p r a c t i c a l problems t h a t must be r e s o l v e d b e f o r e  the i d e a l can be  achieved.  For those r e s p o n s i b l e f o r p r o v i d i n g c o n t i n u i n g  education,  a major problem i s i t s marginal s t a t u s i n the eyes o f governments as w e l l 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 o f t h i s p e r c e i v e d m a r g i n a l i t y are a l a c k o f funds and  a shortage o f a p p r o p r i a t e l y t r a i n e d h e a l t h education  The  geographical  manpower.  remoteness o f many p r a c t i c i n g h e a l t h p r o f e s s i o n a l s  makes these even more s i g n i f i c a n t .  T h i s i s borne out by p r o f e s -  s i o n a l s who c i t e an i n a b i l i t y t o leave t h e i r work s i t u a t i o n ,  costs,  the time r e q u i r e d and the d i s t a n c e t o be t r a v e l l e d t o attend courses as reasons f o r n o n - p a r t i c i p a t i o n (53). I t i s c l e a r t h a t i f c o n t i n u i n g education e f f e c t i v e means o f p r e v e n t i n g  i s t o p r o v i d e an  p r o f e s s i o n a l obsolescence,  particu-  l a r l y f o r those p r a c t i c i n g i n remote areas, d e l i v e r y systems must be developed t h a t can r e p l a c e the t r a d i t i o n a l approaches t o i n - :. struction.  Such systems must minimize c o s t s , make economical use  of h e a l t h education  manpower, reduce time l o s t i n t r a v e l and  3 s t i m u l a t e i n t e r e s t i n n o n - t r a d i t i o n a l forms o f l e a r n i n g . PURPOSE OF THE STUDY T h i s study d e s c r i b e s the P.A. Woodward Mobile I n s t r u c t i o n a l Resource Centre  (MIRC) P r o j e c t , which was developed t o  respond t o the l e a r n i n g needs of r u r a l h e a l t h p r a c t i t i o n e r s , and analyzes  i t s r o l e i n c o n t i n u i n g education  i n the h e a l t h p r o f e s s i o n s .  PROCEDURE Data were obtained in  from members o f 11 h e a l t h  professions  17 communities i n B r i t i s h Columbia between August 1, 1973 and  March 31, 1974.  The h e a l t h p r o f e s s i o n s were:  d e n t i s t r y , medicine,  n u r s i n g , 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 medic i n e , s o c i a l work, l i c e n s e d p r a c t i c a l n u r s i n g , medical  records  l i b r a r i a n s h i p , medical l a b o r a t o r y technology and r a d i o l o g i c t e c h nology.  Data from n o n - p a r t i c i p a n t s were obtained  from the f i r s t  seven groups. DATA COLLECTION P a r t i c i p a n t s were asked t o complete a data  form d u r i n g  t h e i r f i r s t v i s i t t o the MIRC, and a t o t a l o f 521 were completed. Non-participants  were i d e n t i f i e d from a l i s t o f a l l h e a l t h  pro-  f e s s i o n a l s i n each community v i s i t e d , and a random sample, t o a maximum o f 20 i n each community, was s e l e c t e d . s e l e c t e d was mailed  a questionnaire  MIRC's v i s i t t o t h e i r community.  Each person  d u r i n g the week f o l l o w i n g the  Of the 333 forms mailed,  136  4  were r e t u r n e d f o r a r e t u r n r a t e of 40.8 percent  (Appendix A,  page 115). Data on p a r t i c i p a t i o n r a t e s i n the MIRC p r o j e c t were obt a i n e d from r e c o r d s maintained  d u r i n g the v i s i t t o each community  w h i l e data on p a r t i c i p a t i o n i n other e d u c a t i o n a l a c t i v i t i e s were obtained from r e c o r d s maintained  by the U n i v e r s i t y 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 c a l c u l a t e d and means and standard d e v i a t i o n s o b t a i n e d .  C h i square  measure d i s c r e p a n c i e s between expected  t e s t s were conducted  to  and obtained f r e q u e n c i e s ,  and F t e s t s performed t o t e s t f o r s i g n i f i c a n t d i f f e r e n c e s among subgroup means.  Pearsonian  c o r r e l a t i o n s were c a l c u l a t e d where  a p p r o p r i a t e t o measure the degree of a s s o c i a t i o n between v a r i a b l e s . DEFINITION OF TERMS A d u l t Education - "... any planned  and organized  activity  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 s t r u m e n t a l i t y t h a t i s intended s p e c i f i c a l l y t o a s s i s t an a d u l t t o l e a r n and which i s under the immediate and c o n t i n u i n g s u p e r v i s i o n of an i n s t r u c t i o n a l agent who manages the c o n d i t i o n s f o r l e a r n i n g i n such a way as t o f a c i l i t a t e the s u c c e s s f u l achievement o f the l e a r n i n g o b j e c t i v e s " (82) . C o n t i n u i n g Education l e a r n i n g a c t i v i t i e s designed  i n the H e a l t h Sciences - "systematic t o modify a t t i t u d e s and/or update or  5 enlarge  the knowledge and s k i l l s o f h e a l t h p r o f e s s i o n a l s so t h a t  t h e i r competence i s maintained f o r the purpose of improving  health  care s e r v i c e s " (50). Distance  Education - educational  l e a r n e r s who are g e o g r a p h i c a l l y  separated  a c t i v i t i e s designed f o r from the i n s t i t u t i o n ,  o r g a n i z a t i o n or agency p r o v i d i n g the a c t i v i t i e s . D e l i v e r y System - a means of making l e a r n i n g t i e s accessible to p o t e n t i a l learners.  opportuni-  The term i m p l i e s a pur-  p o s e f u l a c t i v i t y on the p a r t o f a l e a r n i n g agent intended opportunities  f o r l e a r n i n g and t o provide  opportunities  accessible.  to create  a means o f making those  REVIEW OF THE LITERATURE In order  t o provide  a background f o r the examination o f  the MIRC P r o j e c t , t h i s s e c t i o n w i l l review the c o n t i n u i n g t i o n l i t e r a t u r e r e l a t e d t o d i s t a n c e education tioners.  The problem of p r o v i d i n g  who a r e g e o g r a p h i c a l l y  f o r the needs o f a d u l t  practilearners  remote from c e n t r e s o f l e a r n i n g i s not  unique t o the h e a l t h s c i e n c e s . educators f o r c e n t u r i e s . health sciences  f o r health  educa-  I t has been a concern o f a d u l t  Indeed, c o n t i n u i n g  education  i n the  as a whole has emerged only r e c e n t l y as a recog-  n i z a b l e movement w i t h i n the f i e l d o f a d u l t education, most of the approaches taken to p r o v i d i n g l e a r n i n g  so t h a t  opportunities  f o r h e a l t h p r o f e s s i o n a l s i n remote communities have t h e i r o r i g i n s i n the general  development o f the f i e l d .  Because most of the  important d e l i v e r y systems c u r r e n t l y used i n the h e a l t h  sciences  6 have o r i g i n a t e d i n North. America, only l i t e r a t u r e from the U n i t e d S t a t e s and Canada has been i n c l u d e d . T h i s review o f l i t e r a t u r e i n the h e a l t h s c i e n c e s draws h e a v i l y on the e x t e n s i v e c o n t i n u i n g education  review o f North American l i t e r a t u r e i n  i n d e n t i s t r y , medicine, n u r s i n g and pharmacy  p u b l i s h e d by Nakamoto and Verner i n 1973. as i t p e r t a i n s t o d i s t a n c e education ber  1976.  I t extends t h e i r review  i n those p r o f e s s i o n s t o Decem-  L i t e r a t u r e from s i x other p r o f e s s i o n s :  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 l a b o r a t o r y technology and r a d i o l o g i c t e c h nology c o v e r i n g the p e r i o d from January 19 60 t o December 19 76 was reviewed and i s i n c l u d e d because r e p r e s e n t a t i v e s o f these groups a l s o p a r t i c i p a t e d i n the MIRC p r o j e c t . T h i s review w i l l focus on d e l i v e r y systems designed t o meet the needs o f p o t e n t i a l l e a r n e r s who are g e o g r a p h i c a l l y t a n t from major e d u c a t i o n a l c e n t r e s .  dis-  I t w i l l i n c l u d e both those  systems developed f o r d i s t a n t l e a r n e r s by l e a r n i n g agents i n the major e d u c a t i o n a l  centres and those developed by d i s t a n t l e a r n e r s  to meet t h e i r own needs. be presented  D e f i n i t i o n s o f the v a r i o u s systems w i l l  where a p p r o p r i a t e when they are d e s c r i b e d .  g o r i e s o f d e l i v e r y systems used i n t h i s review are:  The c a t e -  home study  systems, off-campus and t r a v e l l i n g courses, media, and communityinitiated  systems.  HOME STUDY One o f the e a r l i e s t and most important means o f p r o v i d i n g  7 l e a r n i n g o p p o r t u n i t i e s t o the g e n e r a l p o p u l a t i o n o f a d u l t l e a r n e r s who a r e a t a d i s t a n c e from t e a c h i n g c e n t r e s i s correspondence study, but formal correspondence  courses have played a r e l a t i v e l y  s m a l l p a r t i n the d i s t a n c e education o f h e a l t h p r a c t i t i o n e r s . Other forms o f home study, most n o t a b l y programmed  instruction,  have been used t o a g r e a t e r extent. Mackenzie (1971) d e f i n e d correspondence "... i n s t r u c t i o n o f f e r e d through  correspondence  i n s t r u c t i o n as which r e q u i r e s  i n t e r a c t i o n between the student and the i n s t r u c t i n g In i t s t r a d i t i o n a l form, correspondence  instition."  study c o n s i s t s o f a s e r i e s  of p r i n t e d l e s s o n s w i t h assignments which the student  completes  and r e t u r n s t o the i n s t r u c t o r f o r marking and s u g g e s t i o n s . has been supplemented by a v a r i e t y o f media:  This  audio-tapes,  and s l i d e s , open o r c l o s e d - c i r c u i t t e l e v i s i o n , v i d e o t a p e , grammed i n s t r u c t i o n , computer a s s i s t e d i n s t r u c t i o n ,  films pro-  telephone  ( t e l e l e c t u r e and c o n s u l t a t i o n s ) and r a d i o (49). Home study i s not a s i g n i f i c a n t f a c t o r i n c o n t i n u i n g education i n any o f the h e a l t h p r o f e s s i o n s .  Medicine,  the only  p r o f e s s i o n which summarizes c o n t i n u i n g education courses by type on an annual b a s i s , r e p o r t e d a t o t a l o f 12 home study courses i n 1969-70 which was 0.59 percent o f a l l courses o f f e r e d (53).  In  1975-76, 67 home study courses were 1.2 percent o f the t o t a l number  (68).  Correspondence and programmed i n s t r u c t i o n a r e the p r i n -  c i p a l home-study d e l i v e r y systems, other than j o u r n a l s , used by other p r o f e s s i o n s as w e l l ; however, no d e s c r i p t i v e s t u d i e s on e i t h e r 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 h e a l t h s c i e n c e s l i t e r a t u r e s i n c e 1970. was  r e p o r t e d by Nakamoto and Verner  (1973), i t i s used f a i r l y  t e n s i v e l y i n c o n t i n u i n g pharmaceutical  education.  The  (53), i s s t i l l  user of t h i s d e l i v e r y system i n D e n t i s t r y . dom  used i n c o n t i n u i n g n u r s i n g  the  ex-  United  S t a t e s Dental Corps, which has been o f f e r i n g c o n t i n u i n g through correspondence s i n c e 1957  As  education  principal  Correspondence i s s e l -  education.  Programmed i n s t r u c t i o n has been d e f i n e d as "...  a self-  i n s t r u c t i o n a l approach to l e a r n i n g i n which i n f o r m a t i o n i s presented i n a c o - o r d i n a t e d frames" (10).  sequence o f question-and-answer steps  As Nakamoto and Verner  (1973) p o i n t e d out,  used most e x t e n s i v e l y i n c o n t i n u i n g education J o u r n a l of the American Pharmaceutical sources  August 1973  (10).  The  appropriateness  f o r c o n t i n u i n g pharmaceutical Mrtek (1971) who tool.  Hodapp and  concluded  Kanun (19 70)  c l o s e d c i r c u i t t e l e v i s i o n and  i n pharmacy.  The 31  f o r pharmacists i n  of programmed  education was  t h a t i t was  i t is  Association l i s t e d  of programmed i n s t r u c t i o n courses  or  instruction  examined by Mrtek  most e f f e c t i v e as a  and  remedial  compared programmed i n s t r u c t i o n  and  found them e q u a l l y e f f e c t i v e i n terms  of c o g n i t i v e g a i n s . The  o n l y study r e p o r t i n g the use of programmed  t i o n i n c o n t i n u i n g d e n t a l education rose  instruc-  s i n c e 19 7 0 i s a study by Mel-  (197 6) conducted by the Department of Pathology of the  of D e n t i s t r y at the U n i v e r s i t y o f Southern C a l i f o r n i a .  School  Approxi-  9 mately 3,100 d e n t i s t s completed an o r a l cancer course which i n cluded a pre- and post t e s t . p a r t i c i p a n t responses, positive.  The r e s u l t s based on t e s t s c o r e s ,  number o f r e f e r r a l s and other measures were  Programmed i n s t r u c t i o n courses on a wide v a r i e t y o f  s u b j e c t s a r e a v a i l a b l e through  the D i v i s i o n o f D e n t a l H e a l t h o f  the United S t a t e s P u b l i c H e a l t h S e r v i c e .  Programmed m a t e r i a l s f o r  g e n e r a l p r a c t i t i o n e r s have been developed  by the D i v i s i o n o f  P e r i o d o n t o l o g y o f the U n i v e r s i t y o f C a l i f o r n i a School o f D e n t i s t r y as w e l l (53). The use o f programmed i n s t r u c t i o n i n medicine has not changed s i g n i f i c a n t l y s i n c e 1970.  and n u r s i n g  Nakamoto and Verner  (19 73) p o i n t e d out t h a t although programmed m a t e r i a l s on a v a r i e t y of t o p i c s are a v a i l a b l e t o d o c t o r s from a number o f sources,  they  r e c e i v e g r e a t e s t use i n c o n t i n u i n g medical e d u c a t i o n as a supplementary d e v i c e i n c o n j u n c t i o n w i t h other forms o f i n s t r u c t i o n . T h e i r use i n n u r s i n g has n o t been e x t e n s i v e .  Adams (1971) de-  s c r i b e d a number o f guided independent study packages on a v a r i e t y of t o p i c s a v a i l a b l e t o nurses  through  the Department o f Nursing a t  the U n i v e r s i t y o f Wisconsin.  The American J o u r n a l o f Nursing i s  p u b l i s h i n g a s e r i e s o f programmed i n s t r u c t i o n supplements on assessment techniques (62). OFF-CAMPUS COURSES An e a r l y approach t o d i s t a n c e education was the t r a v e l l i n g l e c t u r e which has become one o f the p r i n c i p a l d e l i v e r y systems  10 both i n g e n e r a l a d u l t education and i n c o n t i n u i n g e d u c a t i o n i n the health sciences.  Off-campus and t r a v e l l i n g courses a r e a t r a d i -  t i o n a l way o f d e l i v e r i n g c o n t i n u i n g e d u c a t i o n t o r u r a l h e a l t h prof e s s i o n a l s and they a r e mentioned i n the l i t e r a t u r e o f most o f the p r o f e s s i o n s 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 u s u a l l y has a r e g u l a r l y i t i n e r a r y which i n c l u d e s a number of communities, whereas a community course i s o f f e r e d i n a s i n g l e l o c a t i o n ; however, the terms are f r e q u e n t l y used i n t e r c h a n g e a b l y i n the l i t e r a t u r e .  C i r c u i t courses have  been d e f i n e d as "... those presented a t r e l a t i v e l y i s o l a t e d communities by t o u r i n g f a c u l t y 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 t o i n c l u d e a l l types o f community Nakamoto and Verner  (19 73)  courses.  reported that c i r c u i t  courses  were r e c e i v i n g i n c r e a s i n g l y l e s s emphasis i n the l a t e 1960's as a way o f d e l i v e r y c o n t i n u i n g medical e d u c a t i o n . trend seems t o have been r e v e r s e d .  S i n c e then,  this  In 19 69-7 0, o n l y 14 c i r c u i t  courses were r e p o r t e d i n the U n i t e d S t a t e s and they accounted f o r 0.69 percent of a l l courses.  In 1975-76, however, 136 were r e -  ported, accounting f o r 3.25 percent of the t o t a l  (68). This i s  c o n s i s t e n t w i t h the " . . . ( v i r t u a l ) t i d a l wave o f i n t e r e s t i n l e a r n i n g by community p h y s i c i a n s " noted by Strauch Braucher  (1971) p r o v i d e s a summary of programs o f f e r i n g s 'in  c o n t i n u i n g pharmacy e d u c a t i o n . grams sponsored  (1975).  In a f o u r - y e a r comparison o f pro-  by pharmacy schools alone and co-sponsored  with  p r o f e s s i o n a l a s s o c i a t i o n s (19 66-69), he r e p o r t s t h a t the number of off-campus courses was g r e a t e r than the number o f f e r e d on campus  11 each year.  The  number and  p r o p o r t i o n of off-campus courses a c t u a l l y  d e c l i n e d during the p e r i o d , from 158 1969,  (62%)  i n 1966  to 121  (54%)  in  whereas the number and p r o p o r t i o n of on-campus courses r e -  mained f a i r l y  constant.  The  d i f f e r e n c e i s accounted f o r by "com-  b i n a t i o n " courses o f f e r e d 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 r e p o r t e d  accounted f o r seven  percent  of the t o t a l i n t h a t No  i n 19 67 and  year.  g e n e r a l summary o f course o f f e r i n g s by type or l o c a -  t i o n has been p u b l i s h e d by the other p r o f e s s i o n s ; t h e r e f o r e , i t i s not p o s s i b l e 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 d e l i v e r y system t h a t employs a s p e c i a l l y - e q u i p p e d motor v e h i c l e .  Such v e h i c l e s  are used e x t e n s i v e l y f o r d e l i v e r i n g primary h e a l t h care s e r v i c e s i n r u r a l areas (6,13,42). and  (6,18,20,42,48) and  i n p r o v i d i n g consumer  education  They have been used by r e h a b i l i t a t i o n medicine  d e n t i s t r y (20)  i n B r i t i s h Columbia.  Tseitlin  (48)  (1973) r e p o r t e d  d e s c r i p t i o n s and  s p e c i f i c a t i o n s of v e h i c l e s t h a t c o u l d be used f o r  these purposes.  L i m i t e d use has been made o f such v e h i c l e s f o r  c o n t i n u i n g education  for health professionals.  Spicer  (1975) de-  s c r i b e d a p r o j e c t i n A r i z o n a which comprised a s m a l l van s t a f f e d by a r e g i s t e r e d nurse who munities van.  l e d l e a r n i n g experiences  i n r u r a l com-  u s i n g audio v i s u a l equipment and m a t e r i a l s s t o r e d i n the  The  l e a r n i n g experiences  and not i n the van described.  itself.  were conducted i n l o c a l  No other  facilities  s i m i l a r p r o j e c t s have been  12 MEDIA Ely  (1963) d e f i n e d major c a t e g o r i e s of media:  i n s t r u c t i o n a l media and  instructional aids.  The  mass media,  first  two  are  u s e f u l f o r c l a s s i f y i n g mediated d e l i v e r y systems.  Because i n s t r u c -  t i o n a l a i d s were d e f i n e d as "supplementary" i n the  teaching-  l e a r n i n g process  and  "not s e l f - s u p p o r t i n g , they cannot comprise 11  the e s s e n t i a l component of a d e l i v e r y system and while  they w i l l  be mentioned i n d e s c r i p t i o n s of other d e l i v e r y systems, they w i l l not be d e s c r i b e d  separately.  Media has played d i s t a n c e education population  and  an important r o l e i n the development of  d e l i v e r y systems both f o r the g e n e r a l  f o r h e a l t h p r a c t i t i o n e r s . Mass media i s used  t e n s i v e l y i n g e n e r a l a d u l t education education  adult  while  i t s use  i n the h e a l t h s c i e n c e s i s l e s s e x t e n s i v e  ex-  i n continuing i n some r e -  s p e c t s , but with c e r t a i n mass-media d e l i v e r y systems used mainly i n the h e a l t h s c i e n c e s .  The  been n e a r l y as e x t e n s i v e  i n g e n e r a l a d u l t education  c o n t i n u i n g education  use of i n s t r u c t i o n a l media has  i n the h e a l t h  not  as i t has  in  sciences.  Mass Media Mass Media has been d e f i n e d as "the instruments of communication t h a t reach sage" (28) .  Knowles  l a r g e numbers of people with  a common mes-  (1962) -has s a i d t h a t the progress  p r i n c i p a l mass media i n developing f o r e d u c a t i o n a l purposes i s one  programs organized  made- by  the  specifically  of the more s i g n i f i c a n t  adult  13 e d u c a t i o n a l achievments of the modern e r a . used most f r e q u e n t l y i n g e n e r a l  The  a d u l t education  forms of mass media are:  p r i n t media  (newspapers, books, magazines), motion p i c t u r e s , r a d i o and sion.  In 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 ,  televi-  journals  are the only form of p r i n t media used e x t e n s i v e l y ; motion p i c t u r e s are used p r i m a r i l y 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 a i d s ; t e l e v i s i o n i s used e x t e n s i v e l y and  r a d i o to a l e s s e r degree.  Tele-  phone d e l i v e r y systems, which are l e s s o f t e n used i n g e n e r a l education, health  are beginning  adult  to p l a y an important r o l e i n c o n t i n u i n g  education. The  p r i n c i p a l form of p r i n t media used i n c o n t i n u i n g  c a t i o n i n the h e a l t h s c i e n c e s i s the p r o f e s s i o n a l j o u r n a l . p r o f e s s i o n has  a t l e a s t one.  Most have s e v e r a l and  e x c l u s i v e l y w i t h matters r e l a t i n g to e d u c a t i o n . j o u r n a l s o f f e r self-assessment  edu-  Each  some d e a l  Many p r o f e s s i o n a l  systems to t h e i r s u b s c r i b e r s .  The  t y p i c a l system i n v o l v e s an anonymous m u l t i p l e - c h o i c e t e s t which i s mailed  to a t e s t i n g agency.  The  r e s u l t s , a reading  list,  and  i n some cases a d i s c u s s i o n o f i n c o r r e c t responses i s r e t u r n e d , u s u a l l y w i t h i n two weeks.  The  primary purpose i s to s t i m u l a t e i n -  dependent study among members of the p r o f e s s i o n s and  to d i r e c t  t h a t 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 e x t e n s i v e l y i n medicine dentistry  and  (14,39,66,67,68). Although the motion p i c t u r e has played  r o l e i n p r o v i d i n g d i s t a n c e education  a fairly  important  o p p o r t u n i t i e s f o r the  general  14 p o p u l a t i o n o f a d u l t l e a r n e r s , the l i t e r a t u r e i n the h e a l t h s c i e n c e s makes no r e f e r e n c e t o i t s use f o r d e l i v e r i n g education  continuing  to health p r a c t i t i o n e r s . Broadcast  r a d i o played a prominent r o l e i n a d u l t educa-  t i o n between 1920 and 19 60 but i t has been l e s s prominent i n cont i n u i n g education  i n the h e a l t h s c i e n c e s ; however, two-way r a d i o  has been used to some extent. Nakamoto and Verner  (1973) r e p o r t e d t h a t two-way r a d i o  had been used i n c o n t i n u i n g medical education  education  i n n u r s i n g d u r i n g the 1960's.  and i n c o n t i n u i n g  Griswold  (1972) r e p o r t e d  t h a t i t was being used i n c o n t i n u i n g pharmaceutical  education i n  Albany, New York.  Denne (1972) d e s c r i b e d a study conducted by  the Inter-Mountain  Regional M e d i c a l Program i n v o l v i n g s e v e r a l  h e a l t h p r o f e s s i o n s i n 48 h o s p i t a l s i n s i x s t a t e s .  The study  found t h a t more p a r t i c i p a n t s were from r u r a l than from urban areas, and t h a t the m a j o r i t y o f the p h y s i c i a n - p a r t i c i p a n t s i n r u r a l areas d i d not attend courses  away from home.  Problems i n  s c h e d u l i n g , r e c e p t i o n and content were r e p o r t e d and the two-way f a c i l i t y was seldom used.  The study  concluded  t h a t audio  record-  ings and/or a u d i o t a p e - s l i d e programs c o u l d serve the same purpose a t a lower c o s t and a high l e v e l o f s a t i s f a c t i o n f o r the p a r t i c i pants. There are two p r i n c i p a l types o f t e l e v i s i o n d e l i v e r y systems:  broadcast  o r o p e n - c i r c u i t , and c l o s e d - c i r c u i t systems.  Broadcast  o r o p e n - c i r c u i t systems are those  through which "...  programs are r a d i a t e d f o r r e c e p t i o n by any l i s t e n e r or viewer: w i t h -  15 i n range of the s t a t i o n " w h i l e a c l o s e d - c i r c u i t system  "...limits  d i s t r i b u t i o n of an image t o those r e c e i v e r s which are d i r e c t l y connected t o the o r i g i n a t i o n p o i n t by c o a x i a l c a b l e or microwave link"  (28) .  General a d u l t e d u c a t i o n has used b r o a d c a s t systems  more e x t e n s i v e l y than c l o s e d - c i r c u i t w h i l e both types of systems have been used i n c o n t i n u i n g education i n the h e a l t h As Nakamoto and Verner  sciences.  (1973) p o i n t e d out, o p e n - c i r c u i t  t e l e v i s i o n i s used most e x t e n s i v e l y i n c o n t i n u i n g medical t i o n but i t s use appears t o have decreased s i n c e 1970. 12 "TV-Radio"  to s i x (68).  In 1969-70,  courses were r e p o r t e d i n the J o u r n a l of the  Medical Association  (53) and i n 1976-77, the number had  educa-  American  decreased  A study conducted by the Inter-Mountain R e g i o n a l  M e d i c a l Program, which had been p r o v i d i n g o p e n - c i r c u i t  television  programs f o r g e n e r a l p r a c t i t i o n e r s over a p e r i o d of 11 y e r a s , concluded t h a t a c t i v e l e a r n e r - i n v o l v e m e n t , an element  essential for  adequate m o t i v a t i o n , has not been p r o v i d e d f o r i n o p e n - c i r c u i t t e l e v i s i o n t o date and t h a t "the r e s u l t s  ... c a s t doubt on whether  o p e n - c i r c u i t t e l e v i s i o n has enough p o t e n t i a l t o compete w i t h o t h e r means of c o n t i n u i n g medical e d u c a t i o n and l e i s u r e - t i m e programming on commercial  television stations"  (19).  A survey conducted  by  the F a c u l t y of Medicine a t the U n i v e r s i t y of Western O n t a r i o concluded t h a t "Medical e d u c a t i o n a l t e l e v i s i o n i s seen as b e i n g complementary  t o other forms o f c o n t i n u i n g e d u c a t i o n r a t h e r than com-  p l e t e l y s a t i s f y i n g the need f o r such e d u c a t i o n by i t s e l f " O p e n - c i r c u i t t e l e v i s i o n was  (41).  s c a r c e l y used i n c o n t i n u i n g  16  dental education before 19.7Q .(531. Since that time, it has been used extensively in New England and the North Central United State (38,84,85,86). In N ew England, an attempt to provide for active learner participation through the use of a telephone question-andanswer system was abandoned after three years because of a low rate of utilization. However further use of open-circuit television systems was encouraged (38). In the "MIND" region (Minnesota, 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 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 tel 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 p u b l i s h e d on i t s use s i n c e  1970.  C l o 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 d e l i v e r y system f o r c o n t i n u i n g education i n d e n t i s t r y , medicine, n u r s i n g , 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) s t u d i e d p h y s i c i a n and h o s p i t a l charac-  t e r i s t i c s a s s o c i a t e d w i t h the use o f m e d i c a l t e l e v i s i o n i n Southern California.  He r e p o r t e d t h a t the programs were b e i n g viewed  by those p h y s i c i a n s who  "...  are i n g r e a t e s t need of c o n t i n u i n g medical  e d u c a t i o n ; t h a t i s , n o n - s p e c i a l i s t s w i t h the l e a s t t r a i n i n g ,  who,  on the average graduated from m e d i c a l s c h o o l about 20 years  ago  and who  physi-  cians."  admit more p a t i e n t s t o h o s p i t a l than do non-viewing He a l s o found t h a t the viewers tended t o be  associated  w i t h s m a l l e r h o s p i t a l s and concluded t h a t the t e l e v i s i o n network was  an important d e l i v e r y system f o r c o n t i n u i n g e d u c a t i o n i n those  h o s p i t a l s because Caldwell  o t h e r e d u c a t i o n a l o p p o r t u n i t i e s were l i m i t e d .  (1974), r e v i e w i n g n i n e years o f c l o s e d - c i r c u i t programming  by the U n i v e r s i t y o f 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 s e r v i c e when f e d e r a l funds were withdrawn i n 1971.  He  concluded  t h a t t e l e v i s i o n appears to have no more i n h e r e n t magnetism than any other form o f c o n t i n u i n g education and t h a t m o t i v a t i o n t o engage i n l e a r n i n g appears t o hinge on whether or not a p a r t i c u l a r program f i l l s  a need a t the time i t i s presented.  The telephone has not been used t o any g r e a t extent as a d i s t a n c e e d u c a t i o n d e l i v e r y system i n g e n e r a l a d u l t e d u c a t i o n . has achieved some prominence,  however, i n the l a s t few years i n  It  18  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 .  Telephone  systems  have become i n c r e a s i n g l y popular as a means of d e l i v e r i n g c o n t i n u i n g e d u c a t i o n to r u r a l h e a l t h p r a c t i t i o n e r s .  The terms most  commonly used to d e s c r i b e t h i s approach are " t e l e l e c t u r e s " "teleconferences".  and  T e l e l e c t u r e s are f r e q u e n t l y supplemented  e l e c t r o n i c chalkboards or by s l i d e s .  Nakamoto and Verner  by  (197 3)  r e p o r t e d the use of t e l e l e c t u r e s i n c o n t i n u i n g e d u c a t i o n i n medic i n e , n u r s i n g , and pharmacy.  S i n c e 19 70 t h e i r use appears  to have  increased. S i l v e r s t o n and Hansen (1973) d e s c r i b e d a telephone conference system developed a t the U n i v e r s i t y o f Wisconsin which grew from an 18 h o s p i t a l network i n 1965  to 75 h o s p i t a l s i n 1972.  In  t h a t year, approximately o n e - t h i r d o f a t o t a l o f 50,000 hours o f i n s t r u c t i o n p r o v i d e d f o r p r a c t i s i n g p h y s i c i a n s was through telephone conferences.  delivered  An e v a l u a t i o n study found t h a t  p a r t i c i p a n t s showed c o g n i t i v e gains and demonstrated a f t e r a six-month  interval.  ferences were meeting  retention  I t concluded t h a t telephone con-;::':  the g o a l s s e t f o r them.  The U n i v e r s i t y of  Texas H e a l t h S c i e n c e s Centre a t San Antonio has been o p e r a t i n g a t e l e c o n f e r e n c e system f o r p h y s i c i a n s f o r seven years l i n k i n g over 100 h o s p i t a l s i n f i v e s t a t e s w i t h the San A n t o n i o Centre (77). Dyment (1971A) d e s c r i b e d a telephone l e c t u r e - s y s t e m s f o r nurses  and  a l l i e d h e a l t h p r o f e s s i o n a l s developed by the R e g i o n a l M e d i c a l Program i n Western New  York i n v o l v i n g 51 h o s p i t a l s .  Donaldson  (19 68)  d e s c r i b e d a t e l e l e c t u r e system f o r d i e t i t i a n s operated by the  19 U n i v e r s i t y of Wisconsin.  Spears  (1973) r e p o r t e d a study  comparing  r e s u l t s of a two-day workshop and a s e r i e s of t e l e l e c t u r e s on the same t o p i c .  The  study found no s i g n i f i c a n t d i f f e r e n c e s between  the means o f p o s t - t e s t scores and concluded t h a t the t e l e l e c t u r e s were as e f f e c t i v e as the workshop. I n s t r u c t i o n a l Media The  term i n s t r u c t i o n a l media has been d e f i n e d as "devices  which p r e s e n t a complete body o f i n f o r m a t i o n , and are l a r g e l y s u p p o r t i n g r a t h e r than supplementary cess"  (28).  self-  i n the t e a c h i n g - l e a r n i n g pro-  U n l i k e 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 e d u c a t i o n a l experiences t o p o t e n t i a l participants.  Being l a r g e l y s e l f - s u p p o r t i n g , i t p r o v i d e s the  necessary i n s t r u c t i o n a l component, but l e a r n e r access must be accomplished  by adding a d e l i v e r y component.  Several- i n s t r u c -  t i o n a l media d e l i v e r y systems are being used i n c o n t i n u i n g educat i o n i n the h e a l t h s c i e n c e s .  P r i n c i p a l among these are  audiotape  and v i d e o tape s u b s c r i p t i o n s e r v i c e s , telephone d i a l - a c c e s s s e r v i c e s and computer-assisted  instruction.  t r e s , which have been developed  L e a r n i n g resources  i n a number of areas, p r o v i d e an  a d d i t i o n a l system f o r 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 learning resources. developed  Although  cen-  other  l e a r n i n g r e s o u r c e s c e n t r e s have been  t o serve the needs of the g e n e r a l p o p u l a t i o n of a d u l t  l e a r n e r s as w e l l , the development of the other i n s t r u c t i o n a l media d e l i v e r y systems d e s c r i b e d has been most e x t e n s i v e i n the h e a l t h sciences.  20 A number of systems which d e l i v e r audiotapes and  video  tapes to h e a l t h p r o f e s s i o n a l s on a r e g u l a r b a s i s through a subs c r i p t i o n are i n o p e r a t i o n Nakamoto and Verner  a t the present time.  (197 3) , the most e x t e n s i v e  As  audiotape  t i o n s e r v i c e s have been developed f o r c o n t i n u i n g The  l a r g e s t of these i s operated by  t i o n which d i s t r i b u t e s two  reported  medical e d u c a t i o n .  the Audio-Video D i g e s t  i n several countries.  States  mean r a t e f o r a l l 12 groups was  (1972)  subscrip-  anaesthesiologists.  approximately 30 p e r c e n t .  "Pharmatapes" designed p a r t i c u l a r l y  r u r a l pharmacists  The  (32).  to a c a s s e t t e (11).  The  for  American S o c i e t y o f H o s p i t a l Phar-  macists p r o v i d e s a s i m i l a r s e r v i c e  Association  The  of Pharmacists p r o v i d e s an audiotape sub-  scription service called  subscribe  12  ranged from 18 percent of a l l f a m i l y  p r a c t i t i o n e r s to 41 percent of b o a r d - c e r t i f i e d  Philadelphia College  Founda-  Oakley  estimated t h a t p a r t i c i p a t i o n r a t e s i n Audio-Video D i g e s t  The  subscrip-  to four tapes per month i n each of  s u b j e c t areas to s u b s c r i b e r s  t i o n s i n the United  by  (55) .  s e r v i c e provided  Canadian d e n t i s t s by  may  the Canadian Dental  American D i e t e t i c A s s o c i a t i o n o f f e r s a  cassette-a-month s u b s c r i p t i o n p l a n  (70)  and  Thompson  (1966) r e f e r s  to an audiotape correspondence system f o r p h y s i o t h e r a p i s t s .  No  p a r t i c i p a t i o n f i g u r e s f o r these s e r v i c e s have appeared i n the literature. Video tape s u b s c r i p t i o n s e r v i c e s are l e s s developed than those f o r audiotapes, p r i n c i p a l l y because of the h i g h e r c o s t s i n volved.  The  Canadian Dental A s s o c i a t i o n has  decided to postpone  21 entry i n t o the f i e l d  f o r t h i s reason  however, as an important present  are intended  As of May 1,500  1974,  future prospect.  Services operating  (83)  has provided  a bi-weekly video tape s e r v i c e to England S t a t e s f o r the  (1974) d e f i n e d a d i a l access  system as an  access to b r i e f  summaries, with a t y p i c a l message between four and  infor-  recorded  e i g h t minutes  T h i s system appears to be unique to the h e a l t h s c i e n c e s . Nakamoto and Verner  (1973) p o i n t e d out t h a t d i a l  systems were being used most e x t e n s i v e l y i n c o n t i n u i n g and  t h a t they had been i n t r o d u c e d  i n the United S t a t e s . s e r v i c e p r i o r to 1970  The was  Pearson  access  medical  i n Canada as w e l l as  only other p r o f e s s i o n to i n i t i a t e a nursing.  l a r g e l y unchanged, although grown.  The  s i t u a t i o n appears to be  the scope of the s e r v i c e s may  (1974) r e p o r t e d 13 d i a l access  United S t a t e s and Canada s e r v i n g 20 s t a t e s and  have  systems i n the provinces.  Although no o b j e c t i v e data has been p u b l i s h e d , two i n d i c a t e t h a t the use o f a d i a l access proved p a t i e n t c a r e . study  past  (54).  mation s e r v i c e t h a t provides telephone  education  over  and The Network f o r C o n t i n u i n g  i n s t i t u t i o n s i n the New  Pearson  in length.  at  education.  the Los Angeles Ear Research I n s t i t u t e had  Medical Education  ten years  I t i s seen by some,  p r i m a r i l y f o r c o n t i n u i n g medical  monthly s u b s c r i b e r s  more than 800  (11).  l i b r a r y may  studies  r e s u l t i n im-  S i l v e r s t o n and Hansen (1973) d e s c r i b e d a  conducted at the U n i v e r s i t y of Wisconsin  which found t h a t  22 n e a r l y o n e - t h i r d o f the c a l l s r e s u l t e d i n a r e p o r t e d change i n behaviour by the p h y s i c i a n .  Pearson  (1974) r e p o r t e d a more com-  prehensive study i n v o l v i n g a l l d i a l access s e r v i c e s i n o p e r a t i o n a t the time and found t h a t nurses and p h y s i c i a n s were the h e a v i e s t users of the s e r v i c e s , w i t h approximately twice as many c a l l s i n g made by nurses as by p h y s i c i a n s . d e n t i s t s and pharmacists even though professions.  Some c a l l s were made by i t was  not intended f o r those  P r o p o r t i o n a l l y more c a l l e r s were from r u r a l  from urban areas.  be-  than  The Users i n d i c a t e d t h a t they had changed  or more aspects of t h e i r p r a c t i c e based on what they had and t h a t they had gained c o n f i d e n c e i n managing p a t i e n t  one  heard problems;  however, they a l s o i n d i c a t e d t h a t they would not pay a nominal amount (even t o l l charges) Ertel as "an approach  f o r the use of the s e r v i c e .  (1972) d e f i n e d computer-assisted i n s t r u c t i o n  (CAI)  to education i n which the i n s t r u c t i o n a l program  and some e d u c a t i o n a l m a t e r i a l s are s t o r e d i n a computer and  uti-  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  d e l i v e r y systems seem more a p p r o p r i a t e f o r the pre-  p a r a t o r y t r a i n i n g of students or f o r courses i n major c e n t r e s than for distance education.  The s i t u a t i o n i n the h e a l t h s c i e n c e s may  be changing to some e x t e n t .  H o f f e r (1975) d e s c r i b e d a s m a l l - s c a l e  study o f the use of computer-assisted i n s t r u c t i o n i n f i v e community h o s p i t a l s i n Michigan, Massachusetts, C a l i f o r n i a and Ohio.  A ter-  minal connected to the computer a t Boston Massachusetts  General  H o s p i t a l was  hospital.  p l a c e d i n the emergency department  of each  23 A number of p h y s i c i a n s , nurses and para-medical p e r s o n n e l were r e c e p t i v e t o CAI and c o n s i d e r e d i t a v a l u a b l e r e s o u r c e , and study concluded  t h a t CAI  "... appears  to have a p o s i t i v e  the  impact  on p h y s i c i a n behaviour." L e a r n i n g resources c e n t r e s capable of d i s t r i b u t i n g  and,  i n some cases, producing a wide v a r i e t y of l e a r n i n g resources have been developed  i n Canada and the U n i t e d S t a t e s , some f o r g e n e r a l  a d u l t e d u c a t i o n and other e x c l u s i v e l y f o r the h e a l t h s c i e n c e s . Nakamoto and Verner  (19 73) r e p o r t e d t h a t s e v e r a l were being  de-  veloped f o r p h y s i c i a n s and other h e a l t h p r o f e s s i o n a l s through  the  Regional M e d i c a l Programs i n the U n i t e d S t a t e s and t h a t a number o f others were being operated by u n i v e r s i t i e s , p r o f e s s i o n a l c i a t i o n s and f e d e r a l government agencies.  asso-  These c e n t r e s , which  d i s t r i b u t e m a t e r i a l s on a loan or r e n t a l b a s i s , p r o v i d e a v a l u a b l e support system f o r a d u l t l e a r n e r s i n r u r a l areas by s u p p l y i n g m a t e r i a l s to i n d i v i d u a l s f o r independent i n s t r u c t i o n i n programs i n i t i a t e d by  study and a i d s to support  communities.  COMMUNITY-INITIATED SYSTEMS A fundamental p r i n c i p l e of a d u l t education i s t h a t i f maximum l e a r n i n g i s to occur, a p p r o p r i a t e l e a r n i n g o p p o r t u n i t i e s must be a v a i l a b l e when the need to l e a r n a r i s e s .  A l l too  q u e n t l y , t h i s i s not the case i n d i s t a n c e e d u c a t i o n .  Content f o r  l e a r n i n g experiences and schedules are o f t e n determined adequate c o n s u l t a t i o n with the p r o s p e c t i v e l e a r n e r s .  fre-  without Consequently,  24  d i s t a n c e education  d e l i v e r y systems do not always provide the  kinds o f l e a r n i n g o p p o r t u n i t i e s time they a r e r e q u i r e d .  t h a t are most a p p r o p r i a t e  a t the  To compensate f o r these d e f i c i e n c i e s ,  a d u l t l e a r n e r s have tended t o t u r n t o i n f o r m a l types o f l e a r n i n g o p p o r t u n i t i e s such as c o n s u l t a t i o n s w i t h l o c a l a u t h o r i t i e s and to r e l e v a n t l i t e r a t u r e .  When more comprehensive i n v e s t i g a t i o n s  o f a t o p i c have been r e q u i r e d , they have formed primary l e a r n i n g groups t o examine and d i s c u s s matters o f mutual i n t e r e s t , and they have arranged formal forms o f organized  courses and workshops.  The two p r i n c i p a l  l e a r n i n g a c t i v i t i e s i n i t i a t e d w i t h i n l o c a l com-  munities have been d i s c u s s i o n groups and s h o r t courses. groups have been used both by the g e n e r a l p o p u l a t i o n l e a r n e r s and by h e a l t h p r o f e s s i o n a l s . f o r the g e n e r a l educational  adult population  Discussion  of adult  Community-initiated  tend t o be organized  a u t h o r i t i e s r a t h e r than by the l e a r n e r s  This i s not the case i n the h e a l t h  Discussion  courses  by l o c a l  themselves.  sciences.  Groups  A d i s c u s s i o n group i s "...a l e a r n i n g s i t u a t i o n which conforms t o 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 p r o c e s s e s o f a group so t h a t l e a r n i n g i s achieved  by the group as a u n i t as w e l l 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 f o r l e a r n i n g i s shared e q u a l l y by the group members and the i n s t r u c t i o n a l agent" (81).  The use o f d i s c u s s i o n groups i s r e f e r r e d t o f r e q u e n t l y i n  the d i s t a n c e education  l i t e r a t u r e using a v a r i e t y o f terms such as  25 study  c l u b s , reading c i r c l e s ,  the nature  l i s t e n i n g groups, and o t h e r s , but  of the a c t i v i t y i s the same.  been used i n g e n e r a l a d u l t education  D i s c u s s i o n groups have  and i n c o n t i n u i n g  i n the h e a l t h s c i e n c e s , both by agencies  education  as a means t o p r o v i d e  l e a r n i n g o p p o r t u n i t i e s f o r a d u l t s i n t h e i r communities and by a d u l t l e a r n e r s themselves to s a t i s f y t h e i r own l e a r n i n g needs. Nakamoto and Verner  (1973) r e p o r t e d t h a t the f i r s t  h e a l t h p r o f e s s i o n to use d i s c u s s i o n groups e x t e n s i v e l y was dentistry.  They p o i n t e d out t h a t these groups, c a l l e d study  have two c h a r a c t e r i s t i c s  t h a t make them p a r t i c u l a r l y  1) the members a r e i n v o l v e d i n p l a n n i n g  clubs,  effective:  t h e i r own education, and  2) as small i n f o r m a l primary groups, they provide  f o r member i n -  teraction  techniques  and f a c i l i t a t e the use o f i n s t r u c t i o n a l  high l e a r n e r  participation.  In d e n t i s t r y , approaches taken by study members a c c e p t i n g r e s p o n s i b i l i t y rotating  with  fordirecting  c l u b s vary,  the group on a  b a s i s , o r through the use o f o u t s i d e r e s o u r c e  personnel.  In most cases, the primary emphasis i s on c l i n i c a l s k i l l s . December 1976, seven s t a t e s and two p r o v i n c e s  with  accepted  As o f  participa-  t i o n i n d e n t a l study  c l u b a c t i v i t i e s f o r c r e d i t toward mandatory  c o n t i n u i n g education  requirements.  been r e p o r t e d i n medicine (70).  Johnson  the 1960's.  Since 1970, study  clubs have  (16,7 7), pharmacy (55), and d i e t e t i c s  (1966) r e p o r t e d t h e i r use i n physiotherapy  during  In almost a l l cases, members o f the group a r e respon-  s i b l e f o r the p l a n n i n g and o r g a n i z a t i o n .  Because c o s t s a r e u s u a l l y  l i m i t e d and arrangements r e l a t i v e l y easy t o make, study  clubs are  26 p a r t i c u l a r l y v a l u a b l e to h e a l t h p r a c t i t i o n e r s i n s m a l l e r  rural  communities. Community-Initiated  Courses  Courses developed by a d u l t l e a r n e r s i n t h e i r  communities  to meet t h e i r own  l e a r n i n g needs seem to be more p r e v a l e n t i n con-  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 than i n g e n e r a l a d u l t edu-  cation.  Nakamoto and Verner  and other l e a r n i n g experiences The  trend appears to be Hiss  (1973) noted a t r e n d toward  developed i n community h o s p i t a l s .  continuing.  (197 6) d e s c r i b e d two  used i n c o n t i n u i n g medical  types of approaches commonly  education:  1) formal  programscorgahized  by a l o c a l c o - o r d i n a t o r or a p l a n n i n g committee, and f e r e n c e s , which may  2) s t a f f con-  c o n s i s t of p r e s e n t a t i o n s by l o c a l or  a u t h o r i t i e s , d i s c u s s i o n s of r e c o r d a u d i t s , x-ray other s i m i l a r a c t i v i t i e s .  Both H i s s  visiting  conferences  (1976) and Brock  learning  t h a t i s emerging i n other p r o f e s s i o n s as w e l l :  appointment of l o c a l c o - o r d i n a t o r s .  and  (1975) men-  t i o n e d an aspect of the trend toward c o m m u n i t y - i n i t i a t e d experiences  courses  the  These c o - o r d i n a t o r s are  local  h e a l t h p r o f e s s i o n a l s s e l e c t e d by t h e i r c o l l e a g u e s or by a c e n t r a l agency to i n i t i a t e and t h e i r communities.  sometimes d i r e c t l e a r n i n g experiences  An e x t e n s i v e system of c o - o r d i n a t o r s was  l i s h e d by the D i v i s i o n of C o n t i n u i n g  Education  U n i v e r s i t y of B r i t i s h Columbia i n 1976 A s s o c i a t i o n Task Force on C o n t i n u i n g February 1976  (5).  estab-  i n Pharmacy at the  The Canadian  Education  in  Dental  recommended i n  t h a t a n a t i o n a l network of r e g i o n a l c o - o r d i n a t o r s  27 be e s t a b l i s h e d .  The  c o - o r d i n a t o r s would be  remote from t e a c h i n g centres and,  supported  l o c a t e d i n communities by m a t e r i a l s and  funds  from the Canadian Dental A s s o c i a t i o n , would be r e s p o n s i b l e f o r c o n t i n u i n g education these  l o c a l and  ment of two  i n t h e i r regions  (11).  The  appointment of  r e g i o n a l c o - o r d i n a t o r s appears to an acknowledge-  important  principles:  to be d e l i v e r e d i n a way  1)  i f c o n t i n u i n g education  t h a t i s l i k e l y to meet community needs,  at l e a s t a p o r t i o n o f the r e s p o n s i b i l i t y must r e s t w i t h h e a l t h p r a c t i t i o n e r s , and and  is  2)  local  l o c a l p r a c t i t i o n e r s are capable  interested i n accepting t h i s  responsibility.  of  28  CHAPTER I I  THE MIRC PROJECT In t h i s c h a p t e r , the h i s t o r y and o r i g i n s o f the P. A. Woodward Mobile I n s t r u c t i o n a l Resource Centre j e c t , i t s purposes,  (MIRC) pro-  and the manner i n which i t was operated and  administered w i l l be d e s c r i b e d . ORIGINS OF THE PROJECT The D i v i s i o n o f C o n t i n u i n g Education i n the H e a l t h Sciences a t the U n i v e r s i t y o f B r i t i s h Columbia  was e s t a b l i s h e d  on A p r i l 1, 1968 (31). At t h a t time, i t was made up o f r e p r e s e n t a t i v e s from f o u r p r o f e s s i o n s : and d e n t i s t r y .  medicine, n u r s i n g , pharmacy  By August 1973, i t had expanded t o i n c l u d e 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 w e l l ( 4 ) .  One o f the concerns o f the D i v i s i o n has been t h a t  "con-  t i n u i n g education should be a v a i l a b l e where a ( h e a l t h p r o f e s s i o n a l ) practices"  (78). To achieve t h i s , the D i v i s i o n o f C o n t i n u i n g  Education i n Medicine o f f e r e d "Community H o s p i t a l " courses i n s e v e r a l l o c a t i o n s each year.  In 1969-70 and 1970-71, i t co- •  o r d i n a t e d a t e l e v i s i o n s e r i e s which c o n s i s t e d o f 24 programs broadc a s t a t weekly i n t e r v a l s over seven p r i v a t e s t a t i o n s and t h e i r 6 7 satellites  ( 3 ) . During the 1970-71 and 1971-72 program y e a r s , the  D i v i s i o n o f C o n t i n u i n g Nursing E d u c a t i o n conducted  a Coronary and  29 I n t e n s i v e Care P r o j e c t which a t t r a c t e d 1517 locations maintained  (2,3).  The  r e g i s t r a n t s i n 21  D i v i s i o n of C o n t i n u i n g Education  a l e n d i n g l i b r a r y of audiotapes  t h a t had  i n Pharmacy  60  subscribers  i n 1972-73 of whom 48 were i n communities o u t s i d e Greater  Vancouver.  Although such s p e c i a l p r o j e c t s enjoyed c o n s i d e r a b l e success,  their  impact on the o v e r - a l l problem of p r o v i d i n g adequate c o n t i n u i n g education  o p p o r t u n i t i e s f o r r u r a l h e a l t h p r o f e s s i o n a l s was  because of t h e i r l i m i t e d d u r a t i o n and In September 1969  areas of the p r o v i n c e was ported and encouraged was  scope.  the i d e a of a mobile resources  t h a t would take c o n t i n u i n g education  purchased i n January 1970  To achieve  and by August 1973,  with the neces-  munities  Instruc-  (MIRC) P r o j e c t began.  DESCRIPTION OF THE The  sup-  this objective, a vehicle  sary p r e p a r a t i o n s completed, the P. A. Woodward Mobile t i o n a l Resource Centre  centre  opportunities into isolated  i n t r o d u c e d and e n t h u s i a s t i c a l l y  (27).  limited  MIRC  t o t a l number of h e a l t h personnel  i n s m a l l r u r a l com-  i n B r i t i s h Columbia i s such t h a t i t would be  f o r the MIRC to provide the volume and  impossible  scope of c o n t i n u i n g educa-  t i o n o p p o r t u n i t i e s r e q u i r e d to meet t h e i r needs; t h e r e f o r e , i t was intended  t h a t the MIRC should a c t as a stimulus and  a supplement  r a t h e r than a s u b s t i t u t e f o r other c o n t i n u i n g education Specifically,  i t s purposes were:  activities.  30 1.  to s t i m u l a t e the i n t e r e s t of r u r a l h e a l t h p r o f e s s i o n a l s in continuing  2.  education  to make r u r a l h e a l t h p r o f e s s i o n a l s aware o f modes of i n dependent l e a r n i n g u t i l i z i n g audio v i s u a l media and to s t i m u l a t e t h e i r i n t e r e s t i n those p a r t i c u l a r modes, and  3.  t o supplement t h e  c o n t i n u i n g education  a c t i v i t i e s o f the  D i v i s i o n (59). ADMINISTRATION The p r o j e c t was  administered  by a working committee made  up of the d i r e c t o r s of c o n t i n u i n g education  i n d e n t i s t r y , human  n u t r i t i o n , medicine, n u r s i n g , pharmacy, and r e h a b i l i t a t i o n medic i n e , along with r e p r e s e n t a t i v e s from s o c i a l work, a d u l t biomedical  communications, and the Bio-Medical  mittee was  c h a i r e d by the E x e c u t i v e  Library.  education, T h i s com-  D i r e c t o r of the D i v i s i o n .  During the development phase, the committee was  respon-*  s i b l e f o r e s t a b l i s h i n g the purposes, o b t a i n i n g the necessary a n c i a l support, out  a c q u i r i n g the v e h i c l e , d e s i g n i n g  fin-  the p h y s i c a l l a y -  f o r the l e a r n i n g environment, making arrangements f o r i t s reno-  v a t i o n , s e l e c t i n g the equipment and m a t e r i a l s , determining i t i n e r a r y , and approving the design ject.  the  f o r the e v a l u a t i o n of the pro-  During the o p e r a t i o n a l phase i t up-dated the m a t e r i a l s ,  s e l e c t e d a d d i t i o n a l communities to be i n c l u d e d i n the i t i n e r a r y , and made m o d i f i c a t i o n s and changes i n the purpose and of the p r o j e c t as r e q u i r e d .  operation  31  OPERATION The MIRC was a former highway bus"*" converted i n t o a mobile  c o n t i n u i n g education f a c i l i t y by students a t the B r i t i s h  Columbia V o c a t i o n a l School ing  (Figure 1 ) .  I t contained t h r e e  s t a t i o n s , each o f which c o u l d accommodate two people.  s t a t i o n was equipped  learnEach  with a c a s s e t t e tape r e c o r d e r , a c a r o u s e l  s l i d e p r o j e c t o r and a r e a r screen p r o j e c t i o n u n i t .  The s t a t i o n s  were a l s o wired t o 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 v i d e o tape programmes p l a y e d on a h a l f - i n c h b l a c k and-white video tape r e c o r d e r .  One s t a t i o n c o n t i n e d an A u t o t u t o r  (a programmed i n s t r u c t i o n a l d e v i c e which uses s p e c i a l l y 35 mm f i l m ) and another  designed 2  had a c a r t r i d g e movie p r o j e c t o r .  programs were s e l f - c o n t a i n e d treatments  of a p a r t i c u l a r  The topic  ranging i n l e n g t h from a few minutes t o more than an hour and many of  them were supported  by supplementary p r i n t e d m a t e r i a l .  Most of  the programs were intended f o r p h y s i c i a n s with very few f o r d i e t i t i a n s , and none a t a l l s p e c i f i c a l l y f o r p h y s i o t h e r a p i s t s , occupat i o n a l t h e r a p i s t s , l i c e n s e d p r a c t i c a l nurses, medical l i b r a r i a n s , medical nologists  records  laboratory technologists or r a d i o l o g i c tech-  (TABLE I ) .  S p e c i f i c a t i o n s f o r the mechanical aspects o f the v e h i c l e are presented i n Appendix B, page 131. S p e c i f i c a t i o n s f o r the audio v i s u a l equipment a r e presented i n Appendix B, page 131.  FIGURE 1 LAYOUT AND ARRANGEMENT OF THE MOBILE INSTRUCTIONAL RESOURCE CENTRE  LEARNING CARRELS for Audio Cassettes Slide-Tape Film TV Sleeping Area for Driver  Learning Side ORIENTATION and NOTICE B O A R D  STORAGE for Slide Tape Film Cartridge TV Cassettes  TAKE-OUT PRINTED MATERIAL  Counter and Supplies  VIDEOTAPE RECORDER for playback to Carrels STORAGE for TV below STORAGE for Audiotape Cassettes  Storage Side  FILE CARD INDEX  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  OF  TYPE PROFESSION  Audio Tapes No.  %  Slide Tapes No.  %  Dentistry  18  94.7  1  5.3  Dietetics  1  33.3  2  66.6  Medicine  973. 86.5  103  9.2  Nursing  129  Pharmacy S o c i a l Work  TOTAL  96.9  Video Tapes No.  PROGRAM Autotutor Films  Movie Cartridge  No.  No.  %  %  45.0  1168  87.3  106  7.9  No.  19  1.4 0.2  20  1.8  4  3.1  14  1.2  15  1.3  38 100.0 9  TOTAL!  11  55.0  35  2.7  1125  84.2  133  9.9  38  2.8  20  14  1.0  15  1.1  1338  '  1.5  100.0  34  During the p e r i o d from August 1, 1973 the o p e r a t i o n a l phase) to March 31,  1974  (the b e g i n n i n g of  (the end  of the  j e c t y e a r ) , the MIRC v i s i t e d 17 r u r a l communities The  (Figure  c r i t e r i a a p p l i e d i n s e l e c t i n g communities f o r the  f i r s t pro2)\  itinerary  were: 1.  expression  of i n t e r e s t by l o c a l h e a l t h p r o f e s s i o n a l s i n  a v i s i t by the MIRC 2.  s i z e of the l o c a l h o s p i t a l as i n d i c a t e d by the number of beds w i t h p r e f e r e n c e  being  given to communities w i t h  smaller h o s p i t a l s 3.  remoteness from major c o n t i n u i n g preference  4.  being  education  with  given to more remote communities,  nearness to a route between other the  centres  and  locations included i n  itinerary.  A standard  procedure was  a p p l i e d i n each community  Preliminary  a d v e r t i s i n g d e s c r i b i n g the nature and  p r o j e c t and  an a p p r o p r i a t e  purpose of  the  news r e l e a s e were forwarded to the com-  munity p r i o r to the v i s i t . m a t e r i a l a v a i l a b l e and  visited.  An  index l i s t i n g  a p o r t i o n of  the  the hours of o p e r a t i o n were i n c l u d e d i n  t h i s advance m a i l i n g to enable p o t e n t i a l p a r t i c i p a n t s to p l a n schedule f o r using  the MIRC, and  to help them determine the  of l e a r n i n g a c t i v i t y they wished to use.  The-itinerary is-presented  their  type  When the MIRC a r r i v e d  i n Appendix C>  page-133. ~-~  FIGURE 2 COMMUNITIES INCLUDED IN THE MIRC ITINERARY AUGUST 1, 1973 TO MARCH 31, 1974  36  i n the community, a d d i t i o n a l p u b l i c i t y was undertaken by the f i e l d s t a f f t o ensure t h a t a l l l o c a l h e a l t h p r o f e s s i o n a l s were aware t h a t i t was a t the l o c a l h o s p i t a l , where i t remained f o r a week. hours of o p e r a t i o n - a minimum of s i x t y per week - were to a f f o r d maximum o p p o r t u n i t y  f o r participation.''"  The  designed  No fee was  charged. Appointments were necessary at times o f peak demand.  only i n the l a r g e r l o c a t i o n s  A f t e r a p e r i o d of o r i e n t a t i o n , p a r t i c i -  pants were a s s i s t e d i n s e l e c t i n g a program s u i t e d t o t h e i r needs or i n t e r e s t s and then taught  how t o operate  ment along with some suggestions  the a p p r o p r i a t e  equip-  to f a c i l i t a t e t h e i r learning.  A f t e r u s i n g m a t e r i a l s , they were asked t o e v a l u a t e them.  Before  the end of the f i r s t v i s i t , each p a r t i c i p a n t was asked t o complete a q u e s t i o n n a i r e t o gather  data about demographic and employment  c h a r a c t e r i s t i c s , c o n t i n u i n g education to the p r o j e c t .  a c t i v i t i e s , and r e a c t i o n s  No l i m i t s were imposed on the l e n g t h o f time a  p a r t i c i p a n t c o u l d remain i n the MIRC or on the number of v i s i t s t h a t c o u l d be made d u r i n g the schedule  of operation.  ROLE OF THE FIELD SUPERVISOR During  the o p e r a t i o n phase, the f i e l d s u p e r v i s o r s 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-  c e l l a n e o u s d u t i e s r e l a t e d t o p u b l i c i t y , the o p e r a t i o n and main-  V a r i o u s schedules were t e s t e d . Appendix D, page 135.  They are presented i n  37  tenance of the v e h i c l e and tails.  i t s equipment, and a d m i n i s t r a t i v e de-  When the o p e r a t i o n phase began, two  were graduate  supervisors  One  communities had been v i s i t e d ; b a s i c nature of the r o l e was i t d i d have an impact  of these withdrew a f t e r only a  few  so the other continued alone.  The  not a f f e c t e d by t h i s change,  on the amount of time t h a t c o u l d be  although devoted  i n t e r a c t i o n w i t h the p a r t i c i p a n t s . The  e d u c a t i o n a l r o l e played by the f i e l d  s u p e r v i s o r be-  gan with an attempt to s t i m u l a t e i n t e r e s t through v i s i t s t o r s , d e n t i s t s , pharmacists, to  who  students i n the Department of A d u l t E d u c a t i o n were  assigned to the p r o j e c t .  to  field  to doc-  h e a l t h care agencies, and the h o s p i t a l  acquaint h e a l t h care personnel w i t h the nature and purpose of  the p r o j e c t and to encourage them to p a r t i c i p a t e . MIRC, the f u n c t i o n of f a c i l i t a t i n g  l e a r n i n g was  Within  the  added to and com-  bined w i t h s t i m u l a t i n g and m a i n t a i n i n g i n t e r e s t .  The  field  staff  provided o r i e n t a t i o n f o r p a r t i c i p a n t s by s t r e s s i n g the unique aspects of the v a r i o u s types of m a t e r i a l s and a s s i s t e d them i n s e l e c t i n g programs a p p r o p r i a t e 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 a v a i l a b l e .  T h i s was  f o l l o w e d by i n -  s t r u c t i o n i n the o p e r a t i o n of the a p p r o p r i a t e equipment and g e s t i o n s as to how Where two  sug-  i t c o u l d be used most e f f e c t i v e l y f o r l e a r n i n g .  or more p a r t i c i p a n t s were u s i n g a program  simultaneously,  they were encouraged to engage i n d i s c u s s i o n i n order to r e i n f o r c e their learning. The  field  s u p e r v i s o r made no attempt to answer q u e s t i o n s  38  about content. When such questions arose, the participants were asked to consult an authoritative source or others in the communit 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 provide 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 eq ment, and over 1,300 programs, the majority of which were intend for doctors and nurses. The 17 communities included in the itinerary between August 1, 1973 and March 31, 1974 were selected on the basis of their interest in the project, their size, and remoteness. The MIRC spent a sixty-hour week at the hospital in ea 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, th were asked to react to the project and provide information about their demographic and employment characteristics and continuing education activities.  39  CHAPTER I I I  PARTICIPATION AND COMPARISON WITH OTHER PROGRAMS CONDUCTED BY THE DIVISION OF CONTINUING EDUCATION IN THE HEALTH SCIENCES DURING THE SAME PERIOD In t h i s chapter, p a r t i c i p a t i o n i n the MIRC p r o j e c t 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  conducted by the D i v i s i o n d u r i n g the same p e r i o d .  activities  The c l i e n t e l e  served by the MIRC p r o j e c t 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 t o determine whether the same i n d i v i d u a l s were being served by both, and c o s t s o f o p e r a t i o n w i l l be compared. PARTICIPATION Members o f 11 h e a l t h p r o f e s s i o n s from 17 B r i t i s h Columbia communities p a r t i c i p a t e d i n the MIRC p r o j e c t between August 1, 1973  and March 31, 1974.  The p a r t i c i p a t i n g p r o f e s s i o n s comprised  the major c a t e g o r i e s o f h e a l t h workers d e l i v e r i n g d i r e c t p a t i e n t care i n communities o u t s i d e the Lower Mainland a t t h a t time.  The  communities v i s i t e d ranged i n s i z e from approximately  300 t o over  13,000  portion of  i n h a b i t a n t s , and were' l o c a t e d i n the southern  the p r o v i n c e  and along the e a s t coast of Vancouver I s l a n d , between  40 and 500 m i l e s from Vancouver.  A detailed analysis of p a r t i c i p a -  t i o n based on p r o f e s s i o n a l c a t e g o r i e s and c h a r a c t e r i s t i c s o f communities  i s presented  below.  40 PARTICIPATION BY PROFESSION A t o t a l o f 521 h e a l t h p r a c t i t i o n e r s i n 11 p r o f e s s i o n a l c a t e g o r i e s p a r t i c i p a t e d i n the MIRC p r o j e c t d u r i n g the p e r i o d concerned although some o f the p r o f e s s i o n s were not represented s m a l l e r communities.  Only four p r o f e s s i o n s :  medicine,  i n the  nursing,  l i c e n s e d p r a c t i c a l n u r s i n g and x-ray technology were i n c l u d e d i n the group o f p o t e n t i a l p a r t i c i p a n t s i n every l o c a t i o n .  The o n l y  p r o f e s s i o n t o p a r t i c i p a t e i n a l l 17 communities was n u r s i n g .  In  a d d i t i o n t o r e p r e s e n t a t i v e s o f the 11 major p r o f e s s i o n a l c a t e g o r i e s , 92 other h e a l t h - r e l a t e d personnel  p a r t i c i p a t e d i n the p r o j e c t .  cluded  a i d e s , ambulance  i n t h i s group were nurses'  housekeeping and maintenance p e r s o n n e l , and  others.  In-  attendants,  i n d u s t r i a l f i r s t a i d workers  Because the numbers i n each o f these c a t e g o r i e s were  s m a l l , they were not i n c l u d e d i n the a n a l y s i s o f p a r t i c i p a t i o n . The  521 h e a l t h p r o f e s s i o n a l who p a r t i c i p a t e d i n the pro-  j e c t represented cipants  approximately 41 percent  (TABLE I I ) .  The h i g h e s t r a t e s o f p a r t i c i p a t i o n were r e -  corded by p h y s i o t h e r a p i s t s nologists  (58.5%).  (62.5%) and medical l a b o r a t o r y  lowest r a t e s were recorded  and d e n t i s t s (24.4%). MIRC contained being  tech-  T h i s i s s u r p r i s i n g s i n c e the MIRC contained no  m a t e r i a l s designed s p e c i f i c a l l y The  o f the p o t e n t i a l p a r t i -  f o r t h e i r use (see TABLE I , p.33). by medical records  librarians  (23.1%)  T h i s might have been p r e d i c t e d because the  no m a t e r i a l s f o r medical records  l i b r a r i a n s , and  l o c a t e d a t the h o s p i t a l i n each community, i t was not as  a c c e s s i b l e t o d e n t i s t s as i t was t o members o f other  professions.  41 TABLE I I PERCENTAGE DISTRIBUTION AND PARTICIPATION RATES FOR ELEVEN HEALTH PROFESSIONAL CATEGORIES  PROFESSION  PARTICIPANTS NO.  M e d  TlcLolcgy  a t 0 r Y  3 1  Dietetics  %  5  -  POTENTIAL PARTICIPANTS No.  "  9 5  PARTICIPATION RATES  %  4  -  1 9  5  0.96  9  0.71  55.56  60  11.52  147  11.62  40.82  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  S o c i a l Work  15  2.88  43  3.40  34.88  , . ... 211 16.69  32.33  Medicine Nursing  Licensed.Practical , J. .. Nursing T  Dentistry  ^iibrarr ^ 0  5  TOTALS  c  6  68  13.05  10  1.92  3  °'  521 100.0  * Weighted mean X  2  = 28.29  57  d . f . = 10  p^.01  T i  41  1 3  3.24  1  '°  2  1264 100.00  24.39  2 3  '°  8  x = 41.22*  42 In order to determine whether the d i f f e r e n c e s i n p a r t i c i p a t i o n r a t e s among the v a r i o u s p r o f e s s i o n a l groups were s t a t i s tically  s i g n i f i c a n t , a C h i square t e s t was performed and was found  to be s i g n i f i c a n t a t the p<.01 l e v e l view of t h i s , three f u r t h e r questions  (x  2  = 28.29, d . f . = 10).  were i n v e s t i g a t e d .  Did the f a c t t h a t the MIRC contained s p e c i f i c a l l y intended  no l e a r n i n g m a t e r i a l s  f o r c e r t a i n p r o f e s s i o n s d e t e r members o f those  p r o f e s s i o n s from p a r t i c i p a t i n g ?  The p r o f e s s i o n s were grouped  to whether o r not l e a r n i n g m a t e r i a l s were provided and  2  accord-  f o r t h e i r use  a C h i square t e s t was performed on the p r o p o r t i o n s  pants to non-participants."'" (X  In  of p a r t i c i -  Because the t e s t was not s i g n i g i c a n t  = 1.01, d . f . = 1 ) , i t was concluded t h a t the a v a i l a b i l i t y o f  p r o f e s s i o n - s p e c i f i c l e a r n i n g m a t e r i a l s was not a f a c t o r t h a t affected  participation. Did the f a c t t h a t the MIRC was l o c a t e d a t the h o s p i t a l  i n each community a c t as a d e t e r r e n t t o p a r t i c i p a t i o n f o r members of those p r o f e s s i o n s not employed a t the h o s p i t a l ?  Dentistry,  pharmacy and s o c i a l work were the p r o f e s s i o n s whose employment d i d not normally  r e l a t e d i r e c t l y t o the h o s p i t a l .  The r e s u l t o f a C h i  square t e s t performed on the p r o p o r t i o n s o f p a r t i c i p a n t s t o potent i a l p a r t i c i p a n t s i n these three p r o f e s s i o n s  ( c o l l e c t i v e l y ) and  i n the remaining p r o f e s s i o n s taken as a group tended toward ficance  (x  2  signi-  = 2.90, d . f . = 1, p<.10), i n d i c a t i n g t h a t l o c a t i o n  The p r o f e s s i o n s f o r whom no l e a r n i n g m a t e r i a l s were s p e c i f i c a l l y intended was l i s t e d i n Chapter I I .  43  of employment may have been a factor that influenced participation to some extent. Were participation rates among these professions for wh 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 programs for licensed practical nurses, medical laboratory technologists, medical records librarians and social workers. A Chi squar 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 = 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 who the Division provided other forms of learning opportunities were somewhat more likely to participate in the MIRC project than thos for whom it did not. PARTICIPATION BY LOCATION 2  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 professionals 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 r a t e s i n the v a r i o u s  t i e s ranged from 76.2  percent  Powell R i v e r .  The mean p a r t i c i p a t i o n r a t e was  l a r g e s t community was a l s o had was  i n Chemainus to 24.0  1,648.  150  i n h a b i t a n t s and  s m a l l e s t h o s p i t a l (17 beds) was l a t i o n was  percent  41.2  in  percent.  The  Powell R i v e r with 13,726 i n h a b i t a n t s , which  the l a r g e s t h o s p i t a l :  Ganges with 329  communi-  beds.  The  a 25 bed  smallest  community  h o s p i t a l ; and  the  l o c a t e d i n Armstrong, whose popu-  The mean community s i z e was  3,750, and  the mean  h o s p i t a l s i z e 54 beds (TABLE I I I ) . To t e s t the r e l a t i o n s h i p between community s i z e p a r t i c i p a t i o n r a t e s , Pearsonian c o r r e l a t i o n s . w e r e found to be Therefore, higher  s i g n i f i c a n t at the p<.05 l e v e l i t appears t h a t smaller  and  calculated  (r - -.492, d.f. =  and 17).  communities tended to have  p a r t i c i p a t i o n r a t e s than l a r g e r communities.  PARTICIPATION BY HOSPITAL SIZE A f u r t h e r t e s t determined t h a t p a r t i c i p a t i o n r a t e s were a l s o n e g a t i v e l y r e l a t e d to the s i z e of the l o c a l h o s p i t a l as measured by the number o f beds (r= -.503, d . f . = 17, t i n g the data r e v e a l e d  p<.05).  Plot-  t h a t , w i t h three exceptions, p a r t i c i p a t i o n  r a t e s i n communities having h o s p i t a l s 40 beds or s m a l l e r were  higher  than those i n communities with h o s p i t a l s l a r g e r than 40 beds (Figure 3).  A Chi square t e s t r e v e a l e d  f i c a n t l y higher  i n communities with smaller h o s p i t a l s  fewer) than i n those i n l a r g e r h o s p i t a l s p< .005) .  t h a t the r a t e s were s i g n i -  (x  2  (40 beds or  = 45.051, d.f. =  1,  45  TABLE I I I COMPARISON OF COMMUNITIES BY PARTICIPATION RATES, POPULATION AND NUMBER". OF LOCAL HOSPITAL BEDS " •  COMMUNITY  NUMBER OF PARTICIPANTS  NUMBER OF POTENTIAL PARTICIPANTS  PARTICIPATION RATES  POPULATION OF TOWNSHIP  NUMBER OF BEDS  Chemainus  32  43  76.19  2170  37  A l e r t Bay  29  40  72.50  760  40  Ganges  25  37  67.57  329  25  Enderby  24  36  66.67  1158  23  Golden  27  45  60.00  3000  40  Armstrong  16  28  57.14  1648  17  Squamish  22  45  48. 89  6121  24  Campbell R i v e r  65  143  45.45  10,000  96  Ladysmith  27  67  40.29  3664  49  Comox  81  211:  38. 39  3980  120  Revelstoke  21  59  35.29  4897  50  Lillooet  12  34  35.29  1514  30  Sechelt  36  107  33.64  590  70  6  18  33.33  494  25  Salmon Arm  41  125  32. 80  7793  93  Ashcroft  13  44  29.55  1916  32  Powell R i v e r  44  183  24.04  13,726  150  TOTALS  521  1264  Lytton  * Weighted mean  x=41.22*  x=3,750.58  x=54  46'  FIGURE 3 PARTICIPATION RATES BY HOSPITAL  P A R T I C I P A T I 0 N  R A T E S  SIZE  100-  90<  80^  70  60  50  I N  40  P E R C E N T  30  CftKlCAL  20  HOSPITAL  £IZ£  10  i  i  i  i  1  i  i  i  i  •  •  i  •  i  i  10 20 30 40 50 60 70 80 90 100 H O 120 130 140 150 NUMBER OF HOSPITAL BEDS  47  I f an o b j e c t i v e of the MIRC p r o j e c t i s t o achieve maximum r a t e s of p a r t i c i p a t i o n i n each community v i s i t e d , the r e s u l t s of these t e s t s appear t o suggest t h a t t h i s i s most l i k e l y t o be achieved i n s m a l l e r communities w i t h h o s p i t a l s o f 40 beds or l e s s . T h e r e f o r e , i f the l e n g t h of the v i s i t s  i s uniform and f i x e d , the  p o l i c y of g i v i n g p r e f e r e n c e to s m a l l e r communities appears t o be sound.  However, because the same p e r i o d of time (one week) was  spent i n a l l communities, and because the a c t u a l number of p a r t i c i pants i n most communities with a h o s p i t a l l a r g e r than 4 0 beds  was  g r e a t e r than the number i n communities with s m a l l e r h o s p i t a l s , i t might be a p p r o p r i a t e to r e l a t e the l e n g t h of the v i s i t t o the s i z e of the h o s p i t a l and to t e s t the r e l a t i o n s h i p again when t h i s adjustment has been made. PARTICIPATION BY COMMUNITY DISTANCE The d i s t a n c e of., the communities from Vancouver ranged from 40 to 490 m i l e s .  The mean d i s t a n c e was  194.9 m i l e s .  Because  f e r r y t r a v e l was r e q u i r e d to reach s e v e r a l of the communities, t h e i r d i s t a n c e was c a l c u l a t e d i n terms o f hours of t r a v e l time by automobile as w e l l . v e l l i n g time was  The most d i s t a n t community i n terms o f t r a -  10.89 hours from Vancouver; the n e a r e s t was  hours away, and the mean time d i s t a n c e was  5.08 hours  0.91  (TABLE I V ) .  To t e s t the r e l a t i o n s h i p between p a r t i c i p a t i o n r a t e s and the d i s t a n c e of communities from Vancouver, two Pearsonian c o r r e l a t i o n s were c a l c u l a t e d .  The c o r r e l a t i o n s were .10 w i t h mileage  48  TABLE IV COMPARISON OF COMMUNITIES BY PARTICIPATION RATES" AND DISTANCE'FROM VANCOUVER  PARTICIPATION RATE  LOCATION  DISTANCE MILES  DISTANCE HOURS  Chemainus  76.19  65  2. 70  A l 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  45.45  140  4. 32  Ladysmith  40.29  58  2.54  Comox  38.39  115  3.83  Revelstoke  35.59  398  8.84  Lillooet  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 R i v e r  24.04  108  3.70  41.22*  194.88  5.08  Campbell  River  MEANS * 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. SI OR NC OFWI P CT IH PE AR TION IR NAMS : •COMTP HA ERIM TA HRTIO PROG  Between September 1, 1973 and March 31, 1974, the Division of Continuing Education in the Health Sciences conducted 75 short courses and workshops in 15 locations throughout the province, providing learning opportunities for 2,880 participants from 96 British Columbia communities as well as from other provinces and the United States. Approximately half of the participants in these programs were from the greater Vancouver area, approximately 35 percent living in rural British Columbia communities (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 Colum and 40 percent from Vancouver. Forty percent of pharmacists were from rural British Columbia, 36 percent from Victoria and 24 perc 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  Greater Vancouver  Victoria a "O  Rural British Columbia No.  Q.  Outside British Columbia No.  o. "o  TOTAL No.  Q. "o  No.  a  Dentistry  169  57.68  21  7.17  70  23. 89  33  11.26  293  10. 17  Dietetics  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  28  24.14  42  36.21  46  39.65  0  0.00  116  4. 03  135  78.95  9  5.26  26  15.20  1  0.59  171  5. 94  9  81. 82  0  0.00.  2  18..18  0  0. 00  11  0. 3 8  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  Pharmacy Rehabilitation Medicine Social Others  Work  "5  No.  "o  2880 100.00  51 a c t i v i t i e s other than the MIRC p r o j e c t ,  r e g i s t r a t i o n s between  September 1, 1973 and March 31, 1974 were t a b u l a t e d tions  (more than one r e g i s t r a t i o n by any i n d i v i d u a l )  t r a t i o n s by h e a l t h ated.  professionals  duplica-  and r e g i s -  from o u t s i d e the p r o v i n c e  elimin-  P r o p o r t i o n s were c a l c u l a t e d u s i n g data f o r the number o f  potential participants rates  with  i n each p r o f e s s i o n  (63).  Participation  i n D i v i s i o n programs were compared with r a t e s  project  f o r those p r o f e s s i o n s  f o r whom l e a r n i n g  i n the MIRC  opportunities  were  r e g u l a r l y p r o v i d e d i n the normal programming o f the D i v i s i o n : d e n t i s t r y , d i e t e t i c s , medicine, n u r s i n g , 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 o f 2,474 B r i t i s h Columbia h e a l t h from the s i x p r o f e s s i o n s  served by the D i v i s i o n p a r t i c i p a t e d i n  programs d u r i n g the p e r i o d  concerned, compared t o 392 p a r t i c i -  pants from the same p r o f e s s i o n s The  i n the MIRC p r o j e c t  (TABLE V I ) .  o v e r - a l l p a r t i c i p a t i o n r a t e i n the MIRC p r o j e c t  (42.9%) was  s i g n i f i c a n t l y h i g h e r than the o v e r - a l l r a t e D i v i s i o n programs ( x the  professionals  rates  2  = 438. 302 , .d.f. = l , p < . 0 0 5 ) .  f o r the i n d i v i d u a l p r o f e s s i o n a l  statistically MIRC p r o j e c t  (15.1%) f o r a l l other  significant differences for dentistry  (x  2  2.482, d . f . .= 1 ) , and medicine other three p r o f e s s i o n s ,  groups r e v e a l e d  the r a t e s  2  no  between the D i v i s i o n and the  = 0.011, d.f. (x  Comparing  = 1), d i e t e t i c s ( x  = 0.751, d.f. = 1 ) .  In the  f o r the MIRC p r o j e c t were  2  =  TABLE VI COMPARISON OF PARTICIPATION RATES IN THE MIRC PROJECT AND OTHER DIVISION PROGRAMS BETWEEN AUGUST 1, 1973 AND MARCH 31, 1974  MIRC PROJECT  DIVISION PROGRAMS  PROFESSION  Number of P a r t i cipants  Rehabilitation Medicine  Number o f Potential Participants  Participation Rates  Number of P a r t i cipants  Number of Potential Participants  Participation Rates  170  805  21.24  15  24  62. 50  71  272  26.10  5  9  55.60  1234  4310  36.93  60  147  40.82  Nursing  625  11,182  5.55  278  632  40.82  Pharmacy  116  .1534  7.56  24  59  40. 68  Dentistry  260  1194  21.78  10  41  62.50  TOTALS  2474  16,375  392  912  Dietetics Medicine  * Weighted Means  x=15.11*  x=42.98*  53  s i g n i f i c a n t l y higher than were those f o r the D i v i s i o n : 4 0 . 8 percent compared t o 5 . 6 percent p<.005); 73.650,  (x  2  = 1243.957,  nursing -  d.f. = 1 ,  pharmacy - 4 0 . 7 percent compared t o 7 . 6 percent d.f. = 1 , p < . 0 0 5 ) ;  The  (x  2  = 20.695,  d.f. = 1 ,  2  =  - 6 2 . 5 per-  and r e h a b i l i t a t i o n medicine  cent compared to 2 1 . 2 percent  (x  p<.005).  r e l a t i v e l y high p a r t i c i p a t i o n r a t e f o r d o c t o r s i n  D i v i s i o n programs may  have been accounted  f o r i n p a r t by the com-  munity h o s p i t a l s program operated by the D i v i s i o n of C o n t i n u i n g M e d i c a l E d u c a t i o n which o f f e r e d courses i n s e v e r a l r u r a l  locations  d u r i n g the p e r i o d concerned.  dentists  Moreover, both doctors and  were l a r g e l y self-employed, and t h e r e f o r e may  have found i t r e l a -  t i v e l y easy t o leave t h e i r communities to p a r t i c i p a t e i n l e a r n i n g experiences elsewhere.  The comparison f o r 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 s m a l l number of cases i n v o l v e d . To focus the comparison on o n l y those p r o f e s s i o n a l groups i n communities v i s i t e d by the MIRC, r e g i s t r a n t s i n D i v i s i o n v i t i e s were s o r t e d a c c o r d i n g t o t h e i r home addresses  to  the number of a c t u a l p a r t i c i p a n t s from each community.  acti-  determine Participa-  t i o n r a t e s were c a l c u l a t e d u s i n g the same f i g u r e s f o r the number of p o t e n t i a l p a r t i c i p a n t s and once a g a i n , o n l y those p r o f e s s i o n s regul a r l y served by the normal programming of the D i v i s i o n were i n cluded i n the  comparisons.  I t was grams ranged  found t h a t p a r t i c i p a t i o n r a t e s i n D i v i s i o n pro-  from zero i n r e h a b i l i t a t i o n medicine  3 4 . 7 percent i n medicine,  and d i e t e t i c s t o  compared w i t h a range from 2 4 . 4 percent  i n d e n t i s t r y t o 6 2 . 5 percent i n r e h a b i l i t a t i o n medicine  f o r 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 dietetic (X =4.43, d.f. = 1, p<.05), n ursing ( x = 240.566, d.f. = 1, p<.005), p harmacy ( x = 9.647, d.f. = 1, p<.005) and rehabilitation medicine ( x = 12.707, d.f. = 1, p<.05). There was no significant difference for dentistry ( x =0.20, d.f. = 1) or medicine ( x = 2  2  2  2  2  0.925, d.f.  =  2  1).  PARTICIPATION BY LOCATION Comparing participation in each community visited by the MIRC, it was found that the total number of participants from the 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 " = 233.73, d.f. = 1, p<.005). The number of participants in Division activities from most of the communities 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 Rive 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 2  TABLE V I I 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  Rehabilitation Medicine  Number o f Potential Participants  Number o f Participants i n MIRC P r o j e c t  Number of Participants in Division Activities  Participation Rate: MIRC  Participation Rate: Division  24  15  0  62.50  : 0.0  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  Dietetics  * Weighted Means  x=42.98*  x=12.17*  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 N umber of Number of Partici- ParticiN u m b e r o f Pa'E'ticie.- Partici- pation pation LOCATION ParticiPotential M pI an t s•iPnro-Division pants in M RI aR tC e: Division Rate: R C 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 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  i n Division  activities  ranged from zero percent f o r the communities mentioned t o 22.7 percent f o r Salmon Arm. ranged from 2 4.8  P a r t i c i p a t i o n rates  i n the MIRC p r o j e c t  percent i n Powell R i v e r t o 81.8 percent i n  Chemainus and were s i g n i f i c a n t l y h i g h e r f o r a l l communities (p<.005) except Salmon Arm f o r which the d i f f e r e n c e was not s t a t i s tically significant (x  2  = 2.262, d.f. = 1 ) .  With the e x c e p t i o n o f A l e r t Bay, which i s a very remote community and might t h e r f o r e  have been expected t o 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 munities which p r o v i d e d no p a r t i c i p a n t s low  i n the MIRC p r o j e c t  as w e l l .  i n the com-  i n D i v i s i o n a c t i v i t i e s were  L i l l o o e t , L y t t o n and A s h c r o f t  were a l l below the group mean, even though t h e i r h o s p i t a l s had fewer than 40 beds and they t h e r e f o r e record  higher  might have been expected t o  rates. COMPARISON OF CLIENTELE  In order t o determine whether the same i n d i v i d u a l s were being served by the MIRC p r o j e c t the  and other D i v i s i o n  activities,  l i s t s o f p a r t i c i p a n t s ' names from each community were compared.  I t was found t h a t o f a t o t a l o f 433 p a r t i c i p a n t s , 342 (77.2%) p a r t i cipated 50  i n the MIRC p r o j e c t but not i n any other D i v i s i o n  (11.3%) p a r t i c i p a t e d i n the MIRC p r o j e c t  activity;  and a t l e a s t one other  D i v i s i o n a c t i v i t y and 51 . (llv.5%). p a r t i c i p a t e d i n a t l e a s t one D i v i s i o n a c t i v i t y but d i d not p a r t i c i p a t e i n the MIRC p r o j e c t  (TABLE I X ) .  58  TAP BA LR ETICIIXPATING IN MIRC PROJECT AND CO M P A R I S O N O F I N D I V I D U A L S OTHER DIVISION PROGRAMS BY PARTICIPANTS' HOME COMMUNITIES PARTICIPATION Division M IdRCDivision Project "'" M I R Cct COMMUNITIES Activities a n P r o j e Only Activities 'Only No. No. No. No. Chemainus 2 6.89 1 3'i45. 26 896. 6 29 Alert Bay 0 0.0 0 0.0 16 100 .00 16 Ganges 0 0.0 1 5.56 17 94.44 18 Enderby 2 11.11 1 5.56 15 83.33 18 Golden 2 8.70 1 434. 20 86.96 23 Armstrong 0 0.0 1 910. 10 90..90 11 Squamish 1 5.,27 1 5.,27 17 89,4. 6 19 Campbell 54 River 2 3.,71 18 33.,33 34 62.,96 Ladysmith 2 4..55 1 9..09 19 86..36 22 Comox 8 12..70 4 6..35 51 80,.95 63 Revelstoke 5 20..83 3 13,.50 16 66,.67 24 Lillooet 0 0..0 0 0,.0 8 100,.00 8 Sechelt 2 5..88 2 5..88 30 88.24 34 Lytton 0 0.0 0 0.0 4 100.00 4 Salmon Arm 11 26.82 9 21.95 21 51.23 41 Ashcroft 0 0.0 0 0.0 8 100.00 8 Powell River 14 27.45 7 13.73 30 58.82 51 TOTALS 51 11.51 50 11.29 342 77.20 443 %  %  g.  C  Q,  "o  100.00 100.00 10 00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100..00 100.,00 100..00 100.,00 .00 100, 100.00 ou  59 Looking a t the v a r i o u s communities, i t was found t h a t i n each o f seven of the 13 l o c a t i o n s  from which D i v i s i o n  participants  were drawn, only one i n d i v i d u a l p a r t i c i p a t e d both i n the MIRC proj e c t and i n other D i v i s i o n a c t i v i t i e s .  In each o f three o t h e r  l o c a t i o n s , there were four or fewer common p a r t i c i p a n t s .  In these  10 communities, which p r o v i d e d a t o t a l o f 16 common p a r t i c i p a n t s , 133  i n d i v i d u a l s p a r t i c i p a t e d i n the MIRC p r o j e c t o r i n D i v i s i o n  a c t i v i t i e s only. ber  In only three l o c a t i o n s d i d a f a i r l y  l a r g e num-  o f i n d i v i d u a l s p a r t i c i p a t e i n both - Campbell R i v e r :  duals  (33 percent o f the p a r t i c i p a n t s  Arm:  9 individuals  (13.7%).  18 i n d i v i -  from t h a t community); Salmon  (21.95%); and Powell R i v e r :  7 individuals  However, as the percentage f i g u r e s demonstrate, even i n  these l o c a t i o n s , the t o t a l number o f i n d i v i d u a l s p a r t i c i p a t i n g i n the MIRC p r o j e c t o r i n D i v i s i o n a c t i v i t i e s o n l y , g r e a t l y  exceeded  the number o f common p a r t i c i p a n t s . T h e r e f o r e , i t seems t h a t , on the whole, w i t h i n professions  included  i n the r e g u l a r  programming o f the D i v i s i o n ,  the MIRC p r o j e c t  served a d i f f e r e n t s e t o f i n d i v i d u a l s .  the MIRC p r o j e c t  served s e v e r a l p r o f e s s i o n a l  l i b r a r i a n s , x-ray t e c h n o l o g i s t s , f o r c i n g the c o n c l u s i o n  Moreover,  groups not i n c l u d e d  to any a p p r e c i a b l e extent i n other D i v i s i o n a c t i v i t i e s : p r a c t i c a l nurses, medical l a b o r a t o r y  the s i x  technologists,  licensed  medical records  and s o c i a l workers, thus r e i n -  t h a t separate s e t s o f i n d i v i d u a l s were served.  60  -  The  .-  COMPARATIVE COSTS  total  costs  of operating  t h e MIRC p r o j e c t b e t w e e n  September 1, 1973 and M a r c h 31, 1974 were $42,500.28 More t h a n h a l f o f t h i s capital  costs,  amount  ($25,296 . 46) was made, up o f  ($15,445.27) was  operating  s p e n t on e v a l u a t i o n .  project  Approximately  35  In order  concerned, the s t a r t i n g  were a m o r t i z e d  over three  years  starting  t o be $8,432.15. total  costs  capital  - the intended costs  The o p e r a t i n g  f o r the f i r s t  year  tuition  f e e revenue.  cost-recovery operation, and  excluding  the t o t a l  y e a r were  costs  found  brought the  the D i v i s i o n received  amount  i s considered  contributed  cost of operating  $108,546.00  c a l c u l a t e d on a t o be i t s c o s t o f  by f a c u l t i e s ,  schools  the D i v i s i o n during  this  Thereperiod  $159,518.64. In o r d e r  of  of the p r o j e c t .  t o $25,635.97.  B e c a u s e i t s b u d g e t was  salaries  life  costs  p r o f e s s i o n a l a s s o c i a t i o n s w h i c h amounted t o $50,972.64.  fore, was  basis, this  capital  f o r the f i r s t  and e v a l u a t i o n  D u r i n g t h e same p e r i o d , in  ($1,758.55)  t o determine the cost of the  the p e r i o d  amortized  percent  c o s t s , and t h e r e m a i n d e r  during  The  starting  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  t o do e a r l y d e v e l o p m e n t a l work.  was  (TABLE X ) .  t o compare t h e c o s t o f p r o v i d i n g  s e r v i c e s , a common u n i t was  instruction participant.  derived:  t h e two  types  the p a r t i c i p a n t - h o u r - o f -  o r one h o u r o f i n s t r u c t i o n p r o v i d e d  t o an i n d i v i d u a l  Because the D i v i s i o n ' s programs a r e p r o v i d e d f o r  g r o u p s o f p a r t i c i p a n t s , t h e number  of participant-hours-of-  61 TABLE X COSTS OF OPERATING THE MIRC PROJECT BETWEEN AUGUST 1, 1973 AND MARCH 31, 1974  ITEM  AMOUNT FOR FIRST YEAR  AMOUNT  S t a r t i n g C a p i t a l Costs Vehicle Renovations A-V Equipment A-V M a t e r i a l s Project Director  $ 1,423.00 6,14 3.19 4,67 4.3 0 9,227.91 3,828.06 $25,296.46  Amortized S t a r t i n g Costs ($25,296 .46 -f 3)  F i r s t Year Operating Costs Salaries Vehicle Publicity Supplies A-V Repairs T o l l Fees Miscellaneous  $ 8,432.15  .," $ 9,987.96 3,800.85 435.00 312.00 3 64.00 19 5.00 349.40 ;  $15,445.27  E v a l u a t i o n Costs Salaries Supplies & Duplicating Computing Time C l e r i c a l Typing  $  900.00 518.55 100.00 240.00  $ 1,758.55 T o t a l Costs t o March 31, 1974 T o t a l Annual Costs  $15,445.27  $ 1,758.55  $42,500.28 $25,635.97  62 i n s t r u c t i o n p r o v i d e d had to be c a l c u l a t e d by m u l t i p l y i n g ber o f r e g i s t r a n t s i n each program by the l e n g t h i n hours. during  of the program  The sum of the products f o r the 75 programs  the p e r i o d produced the t o t a l number of  of-instruction.  the num-  offered  participant-hours-  Because i n s t r u c t i o n i n the MIRC p r o j e c t was i n -  d i v i d u a l i z e d , the comparable of i n s t r u c t i o n p r o v i d e d .  t o t a l was  The c o s t s  the sum of a l l of the hours  per-participant-hour-of-  i n s t r u c t i o n were c a l c u l a t e d by d i v i d i n g the t o t a l o p e r a t i n g by the t o t a l number of  participant-hours-of-instruction.  The MIRC p r o j e c t period  costs  served 521 p a r t i c i p a n t s during  the  concerned a t a t o t a l c o s t of $25,635.97, making the average  c o s t per p a r t i c i p a n t $49.21 (TABLE X I ) . D i v i s i o n of serving  The t o t a l c o s t to the  i t s 2,880 p a r t i c i p a n t s was  i t s c o s t per p a r t i c i p a n t s l i g h t l y h i g h e r :  $159,518.64, making  $55.38.  The  average  c o s t 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 a v a i l a b l e f o r use) was  $26.23 per hour com-  pared t o a per hour average o f $192.65 f o r the D i v i s i o n ' s hours.  828  Making the comparison on the b a s i s of the common u n i t , the  cost of operating  the MIRC p r o j e c t was  found t o be $16.44,  mately four times as much as the c o s t f o r the D i v i s i o n :  approxi-  $3.89.  I  63 TABLE XI COMPARISON OF COSTS OF THE MIRC PROJECT AND OTHER -DIVISION"PROGRAMS .BETWEEN' AUG11,.' UST1973 .AND MARCH'31,: 1974 ITEM  DIVISION  Operating Costs $159,518.64 Number of Participants 2880 Number of Hours of Instruction 828 N ou fmbe Ir nstroufctiPoanrticipant-Hours 41,005 Cost per Participant Cost per Hour of Instruction Cost per Participant-Hour of Instruction  $55.38 $192.65 $3. 89  MIRC $25,635.97 521 977 1559.3 $49.21 $26.23 $16.44  These figures seem to indicate that the cost to the Division of using group methods to deliver instruction were low 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. I the MIRC project, there were none. In order to attend many o  64  Division's regular  programs, p a r t i c i p a n t s  (or t h e i r employers) had  to pay f o r t r a v e l and accommodation as w e l l as s a l a r y replacement and  t u i t i o n fees.  These f a c t o r s would l i k e l y r a i s e the t o t a l  costs  of the D i v i s i o n ' s other a c t i v i t i e s t o a l e v e l a t l e a s t equal t o the c o s t o f the MIRC p r o j e c t . p a r t i c i p a n t s not involved so using  Moreover, the MIRC p r o j e c t reached 291 i n other D i v i s i o n a c t i v i t i e s ,  and i t d i d  l e s s than one-quarter o f the p r o f e s s i o n a l manpower.  f o r e , i t would seem a p p r o p r i a t e some f u t u r e time, t a k i n g  There-  t o make the comparison again a t  these other f a c t o r s i n t o  consideration.  SUMMARY A t o t a l o f 521 h e a l t h p r a c t i t i o n e r s i n 11 p r o f e s s i o n a l categories visited.  p a r t i c i p a t e d i n the MIRC p r o j e c t i n the 17 communities They represented approximately 41 percent o f the poten-  t i a l participants.  P a r t i c i p a t i o n r a t e s were found t o be s i g n i f i -  c a n t l y h i g h e r among those p r o f e s s i o n s vided  f o r whom the D i v i s i o n pro-  other forms o f l e a r n i n g o p p o r t u n i t i e s  whom i t d i d not,  than among those f o r  and h i g h e r t o a degree t h a t tended toward  signi-  f i c a n c e among p r o f e s s i o n s  based o u t s i d e  pital-based  P a r t i c i p a t i o n r a t e s were not s i g n i f i c a n t l y  professions.  r e l a t e d t o the d i s t a n c e  a h o s p i t a l than among hos-  o f communities from Vancouver, but were  s i g n i f i c a n t l y h i g h e r i n communities w i t h h o s p i t a l s having 40 beds or fewer than i n those w i t h l a r g e r h o s p i t a l s . During the same p e r i o d ,  a t o t a l o f 2,880 h e a l t h  f e s s i o n a l s drawn l a r g e l y from s i x p r o f e s s i o n a l c a t e g o r i e s  propartici-  65 pated i n 75 s h o r t courses and workshops conducted by the D i v i s i o n . Of these,  2,4 74 were from B r i t i s h Columbia and were members o f  those p r o f e s s i o n s  i n c l u d e d i n the D i v i s i o n Committee.  sented approximately 15 percent those p r o f e s s i o n s The  They  repre-  o f the p o t e n t i a l p a r t i c i p a n t s from  i n B r i t i s h Columbia.  o v e r - a l l p a r t i c i p a t i o n r a t e i n the MIRC p r o j e c t was  found t o be s i g n i f i c a n t l y higher  than the r a t e i n other D i v i s i o n  programs, as were the r a t e s f o r n u r s i n g , pharmacy and r e h a b i l i t a t i o n medicine.  The r a t e s f o r the three other p r o f e s s i o n a l groups  d i d not d i f f e r t o a degree t h a t 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 t o be true when only those p r o f e s s i o n a l s from communities v i s i t e d by the MIRC were i n c l u d e d i n the comparison, except t h a t , i n t h i s case, a s i g n i f i c a n t l y h i g h e r p r o p o r t i o n t i a n s p a r t i c i p a t e d i n the MIRC p r o j e c t .  of d i e t i -  In most communities  visited  by the MIRC, p a r t i c i p a t i o n r a t e s among h e a l t h p r o f e s s i o n a l s from those communities were found t o be s i g n i f i c a n t l y h i g h e r MIRC p r o j e c t than i n other D i v i s i o n programs.  The only  i n the exception  was Salmon Arm, where the d i f f e r e n c e i n r a t e s was not s t a t i s t i c a l l y significant.  On the whole, the MIRC p r o j e c t appears t o have  a d i f f e r e n t s e t of i n d i v i d u a l s than were served programs.  served  by other D i v i s i o n  When the two were compared on the b a s i s o f c o s t p e r -  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 , the MIRC p r o j e c t was found t o have c o s t the D i v i s i o n approximately four times as much as i t s other programs. included  Costs t o p a r t i c i p a n t s other than t u i t i o n fees were n o t i n the comparison.  66  CHAPTER IV  CHARACTERISTICS OF PARTICIPANTS In t h i s chapter,  the demographic and employment  t e r i s t i c s as w e l l as the c o n t i n u i n g education t i c i p a n t s o f the MIRC w i l l be d e s c r i b e d .  charac-  a c t i v i t i e s o f par-  A comparison o f p a r t i -  c i p a n t s and n o n - p a r t i c i p a n t s , the r e a c t i o n s o f p a r t i c i p a n t s to the p r o j e c t , the r e l a t i v e p r e f e r e n c e s  o f both groups f o r v a r i o u s de-  l i v e r y systems f o r c o n t i n u i n g education, non-participants  and the reasons given by  f o r not p a r t i c i p a t i n g w i l l a l s o be d e s c r i b e d .  D i f f e r e n c e s among p a r t i c i p a n t s and n o n - p a r t i c i p a n t s w i l l be t e s t e d f o r s i g n i f i c a n c e , as w i l l t h e i r ranking o f a l t e r n a t i v e d e l i v e r y systems.  P a r t i c i p a n t s ' r e a c t i o n s w i l l be t e s t e d t o determine whether  they a r e s i g n i f i c a n t l y r e l a t e d to the s i z e o f t h e i r communities o r t h e i r d i s t a n c e from Vancouver. CHARACTERISTICS OF THE POPULATION In order t o e s t a b l i s h a b a s e - l i n e d e s c r i p t i o n o f the h e a l t h p r o f e s s i o n a l s 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 c o n t i n u i n g education  a c t i v i t i e s from a l l p a r t i c i p a n t s and from a  random sample o f n o n - p a r t i c i p a n t s . were obtained  Thus, the data presented  below  from 521 p a r t i c i p a n t s i n 11 p r o f e s s i o n a l c a t e g o r i e s  and  from 136 n o n - p a r t i c i p a n t s  i n seven p r o f e s s i o n a l c a t e g o r i e s i n  all  17 communities i n c l u d e d 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 d e s c r i b e d are sex, m a r i t a l s t a t u s and  age,  l o c a t i o n of most r e c e n t p r o f e s s i o n a l e d u c a t i o n .  The employment c h a r a c t e r i s t i c s are p r o f e s s i o n , f i e l d o f employment, employment s t a t u s , number of years of p r a c t i c e s i n c e g r a d u a t i o n , and c o n t i n u i t y of p r a c t i c e s i n c e g r a d u a t i o n .  The c o n t i n u i n g educa-  t i o n a c t i v i t i e s i n c l u d e the number of s h o r t courses and workshops attended,  the number of p r o f e s s i o n a l books and i s s u e s o f p r o f e s -  s i o n a l j o u r n a l s read and  the use of media d u r i n g the year p r i o r to  the v i s i t of the MIRC. DEMOGRAPHIC CHARACTERISTICS The m a j o r i t y T h e i r mean age was (Q = 9.15) 11.57). The  3 7.8  (76.7%) of the 657 respondents  were  female.  y e a r s , w i t h 50 percent between 2 8 and  and approximately  70 percent between 26 and  Almost 70 p e r c e n t were married, and o n l y 18.6  49  47  (S.D.  =  were s i n g l e .  l a r g e s t p r o p o r t i o n (40.8%) o b t a i n e d t h e i r most r e c e n t p r o f e s -  s i o n a l education i n B r i t i s h Columbia, w i t h other Canadian p r o v i n c e s accounting f o r 37.1  percent and the U n i t e d S t a t e s 10.4  percent.  EMPLOYMENT CHARACTERISTICS More than h a l f of the respondents w i t h the next l a r g e s t groups, d o c t o r s and nurses, accounting f o r o n l y 12.3 tively.  (54.5%).were nurses,  licensed  percent and  8.7  None of the other p r o f e s s i o n s accounted  f i v e percent of the t o t a l .  practical  percent respec-r. f o r more than  S i x t y - s i x p e r c e n t were employed i n a  68 h o s p i t a l , 18.4  p e r c e n t i n p r i v a t e p r a c t i c e , and  p u b l i c h e a l t h agency.  The remainder  5.2  percent i n a  (10.3%) were employed  where such as i n a s o c i a l s e r v i c e agency or e l s e d i d not  else-  respond.  S i x t y - e i g h t p e r c e n t were employed on a f u l l - t i m e b a s i s ; 22.8 cent p a r t time, and approximately  s i x p e r c e n t were not employed.  T h e i r mean l e n g t h of time i n p r a c t i c e was and s l i g h t l y more than h a l f  per-  10.9  years  (S.D. =  8.3)  (54.6%) had p r a c t i c e d c o n t i n u o u s l y  since graduation. CONTINUING EDUCATION ACTIVITIES The respondents two  had attended an average  of  approximately  s h o r t courses or workshops d u r i n g the year j u s t p r i o r to the  MIRC's v i s i t respond  (x = 1.7,  to t h i s item.  = 2.8), but almost  40 percent d i d not  They had read an average  books (x = 6.3,  S.D.  (x = 16.9,  = 19.1)  S.D.  S.D.  = 21.6)  of s i x p r o f e s s i o n a l  and 17 i s s u e s of p r o f e s s i o n a l j o u r n a l s  d u r i n g the same p e r i o d .  and 16 p e r c e n t , r e s p e c t i v e l y , f a i l e d to respond  T h i r t y - t w o percent 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 d u r i n g the p r e v i o u s year, w i t h 38 percent having used a tape r e c o r d e r , 20 p e r c e n t a t a p e - s l i d e system, 16 percent v i d e o tape and millimetre film. used programmed  Over 40 percent  15 p e r c e n t e i g h t  (41.1%) r e p o r t e d t h a t they  had  instruction.  None of the respondents  i n d i c a t e d t h a t they had  attended  no workshops or had read no books nor j o u r n a l s .  However, as  noted, the "no response" r a t e on these items was  high.  I t may  was be  69 that included in the "no response" category were some responses that should have been recorded as zero. Because the questionnaire 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 participants after the questionnaires were completed indicated that the did not understand the term. Some understood it to mean instructio 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 recent 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 ea was found to be statistically significant at the p<.005 level (X = 12.45, d.f. = 1). 2  70 TABLE XII COMPARISON OF PARTICIPANTS AND NON-PARTICIPANTS DEMOGRAPHIC CHARACTERISTICS ...... "'  CHARACTERISTICS  PARTICIPANTS NO.  SEX*  AGE  MARITAL  STATUS  ON  NON-PARTICIPANTS  %  No.  %  Male  101  19 .38  44  32.35  Female  420  80.62  84  61.76  Mean  37. 55  38. 97  Standard Deviation  11. 56  11. 58  Single  104  20.08  18  13.24  Married  361  69.29  97  71.32  55  10.56  13  9 .56  Other LOCATION OF MOST RECENT PROFESSIONAL EDUCATION  B.C.  213  40.88  55  40.44  Elsewhere i n Canada  200  38.39  43  31.62  95  18.23  26  19 .12  * x  d.f. = 1  2  = 12.45  Other  No s t a t i s t i c a l l y  p<£.005 s i g n i f i c a n t d i f f e r e n c e s were observed on  the o t h e r c h a r a c t e r i s t i c s examined. was 3 7.6 and n o n - p a r t i c i p a n t s 38.9 ( x  The mean age o f p a r t i c i p a n t s 2  = 5.30 5, d . f . = 4 ) .  mately 70 percent o f both groups were married  (x  2  Approxi-  = 2.528, d . f . = 2);  about 40 p e r c e n t had o b t a i n e d t h e i r most r e c e n t p r o f e s s i o n a l educat i o n i n B r i t i s h Columbia, and 38 p e r c e n t o f p a r t i c i p a n t s compared  to 32 percent o f n o n - p a r t i c i p a n t s had been t r a i n e d Canada ( x  elsewhere.in  = 0.98, d.f. = 2 ) .  2  EMPLOYMENT CHARACTERISTICS The p a r t i c i p a n t s were drawn from 11 p r o f e s s i o n s , whereas the n o n - p a r t i c i p a n t s represented  only seven.  When a l l respondents  from both groups were i n c l u d e d i n a comparison on the b a s i s o f profession, a difference s t a t i s t i c a l l y level  (x  2  s i g n i f i c a n t a t the p<.005  = 47.16, d . f . = 10) was observed  (TABLE X I I I ) .  When  the groups were compared on the b a s i s o f e q u i v a l e n t p r o f e s s i o n a l c a t e g o r i e s , the l e v e l o f s i g n i f i c a n c e f e l l  t o p<.01 ( x  2  = 11.47,  d.f. = 6 ) . The m a j o r i t y , and approximately of both groups were nurses.  the same p r o p o r t i o n s ,  However, a h i g h e r p r o p o r t i o n o f non-  p a r t i c i p a n t s were d e n t i s t s , d o c t o r s , s o c i a l workers and p h y s i o t h e r a p i s t s , whereas a higher p r o p o r t i o n o f p a r t i c i p a n t s were pharmacists.  Removing the l a s t f o u r p r o f e s s i o n s from the group of  p a r t i c i p a n t s reduced the magnitude o f the d i f f e r e n c e s , b u t d i f ferences  still  remained.  Approximately 70 percent o f p a r t i c i p a n t s compared t o only 4 8.5  percent o f n o n - p a r t i c i p a n t s were employed i n a h o s p i t a l ,  whereas 27 percent o f n o n - p a r t i c i p a n t s compared t o 17 percent o f p a r t i c i p a n t s were i n p r i v a t e p r a c t i c e (TABLE XIV).  The d i f f e r e n c e s  between the two groups on the b a s i s o f the p r o p o r t i o n s o f respondents i n the v a r i o u s types o f employment s i t u a t i o n s were found t o be statistically  s i g n i f i c a n t a t 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  NON-PARTICIPANTS  PARTICIPANTS  PROFESSION  No.  NO.  %  %  Dentistry  10  1.92  9  6.62  Dietetics  5  0.96  1  0.74  60  11.52  21  15.44  278  53.35  77  56.62  24  4.61  4  2.94  15  2.88  8  5.88  S o c i a l 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  M e d i c a l Laboratory Technology  31  5.95  0,  0.0  M e d i c a l Records Librarianship  3  0.58  0  0.0.'  No Response  0  0.0  8  5.88  136  100.00  Medicine Nursing Pharmacy Rehabilitation  TOTALS  Medicine  521  EQUIVALENT GROUPS ( F i r s t 7 P r o f e s s i o n s )  100.00 x  2  = 11.47  73 TABLE XIV PEP RA CR ET NI TC AI GP EANT DS ISTBRYIBU OFNTPAR ANC DS NON ET MI PO LN OYME CT HI AC RI AP CA TN ET RS ISTI CHARACTERISTICS  PARTICIPANTS NON-PARTICIPANTS NO. % No. % 70.63 66 48.53 368 Hospital FIELD OF EMPLOYMENT* Private Practice 88 16.89 37 27.21 Pg ue bn lc iy c Health 9 6.62 4.79 25 A Social 4 2.94 2.50 A gency Services 13 Other 7 1.34 2 1.47 70.44 83 61.03 367 Full Time EMPLOYMENT STATUS (ns) Part Time 119 22.84 31 22.79 Not At Present 28 5.37 9 6.62 11.7 10.8 Mean Y E A R S O F PRACTICE SINCE Standard GRADUATION (ns) D 8.6 8.2 eviation 54.89 73 53.68 286 CONTINUITYOF Yes P R A C T I C E S I N C E 222 42.61 54 39..71 GRADUATION (ns) No  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 = 0.99, d.f. = 2), with the mean length of * X  2  =  2  p r a c t i c e f o r both between and Approximately 54 percent s i n c e graduation The  (x  2  10.5  and  12 years  of both groups had  = 0.02,  d.f. = 4 ) .  2  practiced  continuously  d.f. = 1 ) .  comparison of p a r t i c i p a n t s and  the b a s i s of demographic and  non-participants  on  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 d i f f e r e n c e s on three v a r i a b l e : l o c a t i o n o f employment.  ( x = 7.43,  sex,  profession  S i g n i f i c a n t l y more n o n - p a r t i c i p a n t s  p a r t i c i p a n t s were d o c t o r s , d e n t i s t s , p h y s i o t h e r a p i s t s and workers, whereas more p a r t i c i p a n t s were pharmacists.  A  and than  social  greater  p r o p o r t i o n of n o n - p a r t i c i p a n t s were employed o u t s i d e a h o s p i t a l . These d i f f e r e n c e s are r e l a t e d . probably  L o c a t i o n of employment  emerged as a s i g n i f i c a n t v a r i a b l e because the MIRC  l o c a t e d at the h o s p i t a l i n each community. p l a c e of employment was  Those whose p r i n c i p a l  not i n a h o s p i t a l may  convenient to p a r t i c i p a t e .  was  have found i t l e s s  The d i f f e r e n c e s on the b a s i s of  pro-  f e s s i o n are accounted f o r i n p a r t by  the f a c t t h a t a s i g n i f i c a n t l y  higher p r o p o r t i o n of n o n - p a r t i c i p a n t s  than p a r t i c i p a n t s were mem-  bers of p r o f e s s i o n s employed o u t s i d e a h o s p i t a l .  Furthermore,  the p r o f e s s i o n s based o u t s i d e a h o s p i t a l tended to be male-dominated, whereas those based at a h o s p i t a l tended to be This may  female-dominated.  help to e x p l a i n d i f f e r e n c e s noted on the b a s i s of  sex.  CONTINUING EDUCATION ACTIVITIES P a r t i c i p a n t s and  non-participants  differed  significantly  only on the b a s i s of the number of p r o f e s s i o n a l books read. cause the  "no  response" r a t e on a l l items was  f a i r l y high,  Bestatis-  t i c a l c a l c u l a t i o n s were based only on a c t u a l responses. The two groups d i d not d i f f e r s i g n i f i c a n t l y on the b a s i s of the number of s h o r t courses or workshops they had attended (X  2  = 2.701, d . f . = 2) w i t h both means f a l l i n g between 1.5  Approximately 40 p e r c e n t d i d not respond  (TABLE XV).  and  1.8.  Non-  p a r t i c i p a n t s had read a s i g n i f i c a n t l y g r e a t e r number of p r o f e s s i o n a l books than p a r t i c i p a n t s o f 5.8  (x  2  = 25.5,  f o r p a r t i c i p a n t s and 8.0  d . f . = 3, p<.005), w i t h a mean  f o r n o n - p a r t i c i p a n t s , but over  percent of both groups f a i l e d to respond.  P a r t i c i p a n t s had read  an average of 16.9  i s s u e s of p r o f e s s i o n a l j o u r n a l s and  p a r t i c i p a n t s 17.2,  but the d i f f e r e n c e was  ficant  (x  2  = 7.75,  d . f . = 4).  30  non-  not s t a t i s t i c a l l y  Approximately  signi-  16 percent of p a r t i -  c i p a n t s and 19 percent :of n o n - p a r t i c i p a n t s d i d not  respond.  G e n e r a l l y speaking, p a r t i c i p a n t s were more f a m i l i a r w i t h the types of media i n c l u d e d i n the comparison,  except programmed  i n s t r u c t i o n and f i l m , w i t h 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 h i g h e r p r o p o r t i o n of  n o n - p a r t i c i p a n t s f a i l e d to respond to these items, when the groups were compared and those who from the comparisons, were observed  two  f a i l e d to respond were excluded  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 d i f f e r e n c e s  (TABLE XVI).  76 TABLE XV PA ER RT CI EC NI TP AA GN ETSDIBSYTRC IO BN UT TI IN OU NING OF P PN ANTS DITIES NON-P EA DR UT CI AC TI IO ACTAINV ACTIVITIES  PARTICIPANTS Se tv ai nd Mean D aa tr id on  NON-PARTICIPANTS MeanStaDnedvairadtion  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 NOFO. POR FOFE IS SS SI UO EN SAL JOURNALS READ (ns) 16.89 19.54 17.24 18.03 * X = 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-participan Approximately 41 percent of participants compared to only 25 percent of non-participants had used a tape recorder, but the difference was not statistically significant (x = 0.40, d.f. = 1). Less than 2 5 percent of both groups had used tape-slide progra 2  2  77 TABLE XVI PERCENTAGE DISTRIBUTION OF PARTICIPANTS NON-PARTICIPANTS BY USE OF MEDIA  TYPE OF MEDIA  PARTICIPANTS o, "O  No.  TAPE-RECORDER  34  25. 00  No  277  53.17  26  26. 47  29  5.56  66  49. 53  Response  d. f . = 1 n,. s.  21.69  19  13. 97  No  369  70.83  45  33. 09  39  7.48  72  52. 94  Response  Yes No  Response  No Response  = 0.878  d. f . = 1 n . s.  18.62  12  8. 82  382  73.32  43  31. 62  42  8.06  81  59. 56  2  = 0.00  d. f . = 1 n . s .  15 . 36  20  14. 71  400  76.78  68  50. 00  41  7.87  48  35. 29  80  Yes No  2  97  x  x  PROGRAMMED INSTRUCTION  = 0.401  113  No  FILM  2  Yes  x  8mm  %  41.27  No  TAPE  No.  215  x  VIDEO  NON-PARTICIPANTS  Yes No  TAPE-SLIDE PROGRAM  AND  2  = 1.48  d. f . = 1 n . s.  Yes  214  41.07  56  41. 18  No  269  51.63  49  36. 03  38  7.29  31  22. 79  No  Response  x  2  = 2.48  d., f . = 1 n . s.  78 video  tape,  and  eight millimetre film.  r a t e among p a r t i c i p a n t s may  The  have been due  lower "no  response"  i n p a r t to the f a c t t h a t  they were s u p e r v i s e d w h i l e they completed the q u e s t i o n n a i r e , whereas the n o n - p a r t i c i p a n t s were not. The  comparison o f p a r t i c i p a n t s and n o n - p a r t i c i p a n t s  the b a s i s of t h e i r c o n t i n u i n g education  a c t i v i t i e s d u r i n g the  v i o u s year i d e n t i f i e d s i g n i f i c a n t d i f f e r e n c e s between the groups only on one eliminated:  v a r i a b l e when the  non-particants  had  REACTIONS OF In order  on pre-  two  "no response" category  was  read more p r o f e s s i o n a l books.  PARTICIPANTS  to o b t a i n t h e i r r e a c t i o n s to the MIRC p r o j e c t ,  p a r t i c i p a n t s were asked to respond to seven items r e l a t i n g to  the  nature of the p r o j e c t , the l e a r n i n g environment, the l e a r n i n g m a t e r i a l s , the schedule of o p e r a t i o n and i n t h e i r community.  the l o c a t i o n of the MIRC  Response c a t e g o r i e s and  assigned weights were:  s t r o n g l y agree 5, agree 4, undecided 3, d i s a g r e e disagree and  1.  The  responses were analyzed  the communities, i n which they  2, and  on the b a s i s of  strongly professions  lived.  REACTIONS BY PROFESSION The  grand mean responses of the p a r t i c i p a n t s on a l l  items ranged between 4.1 not s t r o n g l y ) with  and  4.4  the statements  were worded p o s i t i v e l y , t h i s was  i n d i c a t i n g t h a t they agreed (TABLE XVII).  (but  Since a l l items  i n t e r p r e t e d as a f a v o r a b l e r e -  T A B L E  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 E A N  « EH  u M  En W  en  I T E M S  n Z —  X  T h e  M I R C  v i d e s  a  w h i l e  U Q „  _ S . D .  —  X  o zH  D  S . D .  5"  E  u  P R O F E S S I O N  Q  !a H  _ ffu x ^ S . D . . .  x " S . D .  x  CO  S . D .  _ J p. Z x  S . D  x  S . D .  s  IZ u S aoz  x  a O  cj 5 « H H cd K a D  u o O o S s  CO  o  <  Cd U O M H Z Z r> H H U M  • CJ  H £  ^ S . D .  B Y  u z  D  - a ! x S . D .  P R O J E C T  R E S P O N S E S *  X  CO «  a  W H  M I R C  ID.  o  • J CO  <  M  X  i s . D .  S . L .  F P r o b .  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 . ?  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 .  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  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 .  .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 .  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 .  4 . 3  1.6  4 . 8  0 . 4  4 . 4  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  4 . 7  0 . 6  4 . 4  w o r t h -  o p p o r -  t u n i t y t o  p r o -  w z  CO  X  X V I I  f o r  me  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  v i s u a l  d e -  v i c e s  i n  M I R C  t h e  •  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 n e  M I R C  v i d e s  p r o -  m a t e r i a l s  p e r t i n e n t my  t o  n e e d s  E n v i r o n m e n t 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  H o u r s t i o n  o f  o p e r a -  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  0 . 8  0 . 5  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  Q  0 . 8  . 0 ,  80 a c t i o n t o those aspects o f the p r o j e c t r e f e r r e d to i n the s t a t e ments . The  items w i t h the h i g h e s t  grand means (4.4), and on which  there were no s i g n i f i c a n t d i f f e r e n c e s among the p r o f e s s i o n a l groups, were:  "The MIRC p r o v i d e s a worthwhile o p p o r t u n i t y  f o r me  to continue my p r o f e s s i o n a l e d u c a t i o n , " and "The audio v i s u a l dev i c e s i n the MIRC 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 . " This suggests t h a t a l l of the groups tended to r e a c t f a v o r a b l y to the e s s e n t i a l nature o f the p r o j e c t .  A t h i r d item, "The l o c a t i o n  (of the MIRC) was convenient." which a l s o had a grand mean o f 4.4, d i d show s i g n i f i c a n t d i f f e r e n c e s among the v a r i o u s (p<.04).  This r e s u l t appears to be r e l a t e d t o d i f f e r e n c e s among  the p r o f e s s i o n s earlier.  on the b a s i s o f l o c a t i o n of employment,  discussed  The item w i t h the lowest grand mean (4.1), on which  s i g n i f i c a n t d i f f e r e n c e s among the p r o f e s s i o n s (p<.001), was "The MIRC p r o v i d e s m a t e r i a l s The  professions  were a l s o observed  p e r t i n e n t to my needs."  low r a t i n g and the d i f f e r e n c e s between the p r o f e s s i o n a l groups  i s undoubtedly due t o the f a c t t h a t the MIRC contained  no m a t e r i a l s  s p e c i f i c a l l y intended f o r c e r t a i n p a r t i c i p a n t s . REACTIONS BY LOCATION The 4.4,  grand means f o r each item ranged between 4.1 and  as d e s c r i b e d  above; however, an F t e s t determined t h a t  there  were s i g n i f i c a n t d i f f e r e n c e s among the mean r a t i n g o f the v a r i o u s communities on a l l o f the items  (TABLE X V I I I ) .  To determine whether  T A B L E P A R T I C I P A N T  R E A C T I O N  T O  X V I I I  T H E MIRC  MEAN  P R O J E C T  B Y  L O C A T I O N  R E S P O N S E S *  § ITEMS  *  |  i  1  < x  The  MIRC  °  g  -  w S . D .  x  s  c5 S . D .  x  S . D .  x  S  H  - a  I I  CO  m  U  •  8  •  8  as  2  »  wrt  S . D .  x  S . D .  l  §  *  J X  x  s  to S . D .  X  I  §  rt S . D .  x  £  ft  i  s  J S . D .  "  '  w  S . D .  x  a«  gg  Is  g  III u  0 , 0 ; S . D .  x  S . D .  x  S . D .  x  < H  2 H  £  § r  S . D .  U  x  zg O rt cj Hi  rt  S . D .  M  a. a •a  33  n x  M  rt o EH  z  g  u EH  !x  10 3  , S . D .  S . D .  X  p  x  S . D .  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  3 . 3  4 . 4  4 . 2  4 . 4 . 1 . 1  4 . 3  4 . 7  4 . 3  4 . 6  4 . 5  4 . 5  0 . 6  4 . 4  4 . 6  4 . 5  4 . 5  4 . 5  4 . 6  0 . 6  4 . 4  P r o b .  .0002  provides a worthwhile opportunity f c r me t o c o n t i n u e my professional education The  audio  2 . 0  1.1  1 . 3  0 . 5  0 . 7  0 . 6  0 . 5  0 . 5  0 . 5  0 . 6  0 . 5  0 . 6  0 . 5  visual devices facilitate effective learning experiences 2 . 91 . 9  3 . 81 . 3  3 . 7 1.1  4 . 30 . 6  4 . 30 . 9  Environment facilitates concentration  3 . 1 2 . 0 4 . 41 . 0  4 . 0 1 . 3  4 . 31 . 1  4 . 30 . 7  4 . 60 . 5 4 . 7 0 . 5 4 . 30 . 6  Layout i s efficient  3 . 3  4 . 0  4 . 1  4 . 5  4 . 3  Hours o f operation were convenient  3 . 3 2 . 0 4 . 60 . 5 4 . 0 1 . 3  Location  3 . 3 2 . 0 4 . 80 . 4 4 . 2 1 . 3  MIRC  . 0 0 0 1  ' 4 . 20 . 8  The  0 . 8  4 . 0 0 . 4  4 . 30 . 6  4 . 0 0 . 6  4 . 1 0 . 7  4 . 20 . 7  4 . 20 . 7  4 . 1 0 . 7  3 . 90 . 7  4 . 20 . 7  4 . 30 . 7  4 . 1 0 . 8 . 0 0 0 1  4 . 40 . 6 4 . 1 0 . 7 4 . 1 0 . 9  4 . 1 0 . 9  4 . 20 . 6  4 . 1 1 . 0  4 . 20 . 4  4 . 20 . 9  4 . 20 . 9  . 0 0 4  4 . 5  4 . 3  4 . 2  4 . 3  4 . 3  4 . 4  4 . 3  . 0 0 0 5  provides materials pertinent t o my n e e d s  2 . 0  4 . 3  1.1  1 . 3  1.1  3 . 91 . 5  0 . 5  4 . 40 . 6  0 . 5  4 . 3  4 . 6 0 . 5 4 . 3 0 . 5  •• 4 . 1 1.2  0 . 8  4 . 4  0 . 7  4 . 70 . 5  0 . 6  4 . 3  0 . 6  4 . 4  4 . 50 . 7 4 . 70 . 6  4 . 20 . 8  S t r o n g l y  A g r e e  =  5  A g r e e  =  0 . 6  0 . 8  4 . 40 . 5 4 . 1 0 . 5 4 . 4 0 . 5  4 . 5 0 . 5 4 . 60 . 5 4 . 50 . 5 4 . 7 0 . 5 4 . 7 0 . 5 4 . 50 . 5 4 . 5 0 . 5 4 . 50 . 5 4 . 40 . 5 4 . 4 0 . 8  convenient  W e i g h t s :  0 . 6  4  U n d e c i d e d  =  3  0 . 6  4 . 3 0 . 6  0 . 6  4 . 30 . 8  0 . 8  4 . 3 0 . 9 . 0 0 0 1  '  v a s  •Response  0 . 6  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  4 . 5 0 . 5 4 . 40 . 7 , 4 . 40 . 8 . 0 0 0 1  82 these d i f f e r e n c e s were r e l a t e d to the s i z e of the communities or t h e i r distance  from Vancouver, Pearsonian c o r r e l a t i o n s were c a l -  c u l a t e d between r a t i n g s on each item and each community, and  2) t h e i r d i s t a n c e  1) the p o p u l a t i o n  of  i n m i l e s from Vancouver.  None of the c o r r e l a t i o n s between p a r t i c i p a n t s ' responses and  the p o p u l a t i o n  (TABLE XIX).  of communities was  Therefore,  statistically significant  i t appears that community s i z e was  not  a  f a c t o r t h a t accounted f o r d i f f e r e n c e s i n the mean r a t i n g s . A l l of the c o r r e l a t i o n s between responses and from Vancouver were n e g a t i v e , p<.05 l e v e l or l e s s , and  three  w i t h three tending  s i g n i f i c a n t at  distance the  toward s i g n i f i c a n c e .  suggests t h a t remoteness from Vancouver may  This  have been a f a c t o r  which accounted f o r a p o r t i o n of the d i f f e r e n c e i n the mean r a t i n g s , w i t h those nearer Vancouver tending than those f a r t h e r away.  to r e a c t more  This negative r e l a t i o n s h i p may  i n p a r t to the f a c t t h a t 19 of the  have been due  of the f i e l d s u p e r v i s o r s  who  account f o r the very low  The  low  i n p a r t to  the  were l e a r n i n g how  act as f a c i l i t a t o r s as the p r o j e c t proceeded. f a c t o r , i t may  due  communities  v i s i t e d , which were a l s o the f a r t h e s t from Vancouver. r a t i n g s i n these communities may  be  36 item means t h a t f e l l below  the grand means were r e c o r d e d i n the f i r s t f o u r  inexperience  favorably  I f t h i s was  to a  r a t i n g s i n Armstrong,  the  The mean responses to each of the items were t e s t e d  and  f i r s t community v i s i t e d .  inspected  i n an attempt to account f u r t h e r f o r the  noted i n the mean r e a c t i o n s of the v a r i o u s  differences  communities.  Possible  83  TABLE XIX CORRELATIONS BETWEEN PARTICIPANTS' REACTIONS AND COMMUNITY SIZE, AND DISTANCE FROM VANCOUVER  POPULATION REACTION ITEMS Correlation"  L e v e l of Sigriificarice •  DISTANCE FROM VANCOUVER Corfecation  Level of Significarice  The MIRC p r o v i d e s a worthwhile o p p o r t u n i t y f o r me t o continue my p r o f e s s i o n a l education  r =  0.14  n.s.  r = -0.52  p<.02  The audio v i s u a l d e v i c e s i n the MIRC facilitate effective l e a r n i n g experiences  r =  0.05  n.s  r = -0.44  p<.04  The MIRC p r o v i d e s materials pertinent to my needs  r =  0.07  n.s.  r = -0.37  p<.07  Environment facilitates concentration  r = -0.08  n.s,  r--= -0.25  n.s  Layout i s e f f i c i e n t  r =  n.s,  r = -0.46  p<:63  Hours o f o p e r a t i o n were convenient  r = -0.005  n.s,  r = -0.38  p<.07  L o c a t i o n was convenient  r -  r = -0.38  p<.07  0.16  0.07  n.s.  84 e x p l a n a t i o n s were found only f o r f o u r , which are d i s c u s s e d 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 r e l a t i o n s h i p s were found to e x i s t  tween the r e a c t i o n scores and p a r t i c i p a t i o n r a t e s . recorded i n the f i r s t  The  be-  low means  f o u r communities w i l l be noted, but not  dis-  cussed . For the f i r s t o p p o r t u n i t y f o r me of  item:  "The MIRC p r o v i d e s a  to continue my  worthwile  p r o f e s s i o n a l education",  three  the seven means below the grand mean (4.4) were recorded i n the  first  f o u r communities.  (4.0), L i l l o o e t  Three o t h e r s were recorded  i n Lytton  (4.3), and A s h c r o f t (4.3), whose p a r t i c i p a n t s r a t e s  i n the MIRC p r o j e c t were lower than r a t e s i n other communities w i t h h o s p i t a l s of s i m i l a r s i z e , and which provided no p a r t i c i p a n t s i n other D i v i s i o n a c t i v i t i e s .  There may  have been a g e n e r a l l a c k of  i n t e r e s t i n c o n t i n u i n g education i n these communities,during  this  period. For the t h i r d item: t i n e n t to my  "The MIRC p r o v i d e s m a t e r i a l s per-  needs", communities  (other than the f i r s t  r e a c t i o n scores were below the grand mean (4.1)  tended  four) whose to have a  higher p r o p o r t i o n of p a r t i c i p a n t s drawn from those p r o f e s s i o n s f o r whom no s p e c i f i c m a t e r i a l s were provided than d i d communities r e c o r d i n g 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 w i t h the l a r g e s t numbers o f p a r t i c i p a n t s r e corded the lowest means.  Because space i n the MIRC was  limited,  movement' and c o n v e r s a t i o n i n the l e a r n i n g 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) i n d i c a t e s t h a t t h i s was a concern where the l a r g e s t numbers p a r t i c i p a t e d .  However, t h i s  rating  i n d i c a t e s t h a t , on the whole, p a r t i c i p a n t s f e l t t h a t the e n v i r o n ment d i d i n f a c t f a c i l i t a t e For  concentration.  the l a s t item:  v e n i e n t " , communities  "The l o c a t i o n o f the MIRC was con-  r e c o r d i n g the h i g h e s t means:  Squamish (4.7) and L i l l o o e t  Ashcroft  (4.7),  (4.6) were those i n which the MIRC was  c l e a r l y v i s i b l e t o anyone approaching the h o s p i t a l and was only a few yards from a major entrance o r e x i t .  The o n l y means below the  grand mean (4.4) were r e c o r d e d i n the f i r s t f o u r  communities.  RANKINGS OF ALTERNATIVE DELIVERY SYSTEMS In  order t o determine the respondents' p r e f e r e n c e s f o r  c o n t i n u i n g e d u c a t i o n d e l i v e r y systems, both p a r t i c i p a n t s and nonp a r t i c i p a n t s were asked to rank e i g h t d i f f e r e n t systems.  A forced  c h o i c e rank o r d e r i n g was used. The approach t h a t was f i r s t  i n the rank o r d e r i n g by the  group o f respondents as a whole was an audio v i s u a l l e a r n i n g t i o n l o c a t e d i n the h o s p i t a l  (TABLE XX).  sta-  Continued v i s i t s by the  MIRC were second, and l e c t u r e s , seminars, e t c . g i v e n by q u a l i f i e d people from o u t s i d e the l o c a l h e a l t h c a r e community were t h i r d . Least p r e f e r r e d was a loan system f o r books,  journals, e t c .  P a r t i c i p a n t s i n c l u d e d the same t h r e e approaches as the e n t i r e group o f respondents i n t h e i r most p r e f e r r e d c h o i c e s ; however, continued v i s i t s by the MIRC r e c e i v e d a s l i g h t l y lower mean  86 rank than d i d a l e a r n i n g s t a t i o n i n the h o s p i t a l , and were f o r e the p a r t i c i p a n t s ' p r e f e r r e d  approach by a s l i g h t  there-  margin.  Least p r e f e r r e d were l e c t u r e s , seminars, e t c . given by members o f the l o c a l h e a l t h community and a loan system and other p r i n t  f o r books,  journals  materials. TABLE XX  PARTICIPANTS' AND NON-PARTICIPANTS' RANKINGS OF ALTERNATIVE DELIVERY SYSTEMS  DELIVERY SYSTEMS  ALL RESPONDENTS Mean Rank Rank Order  PARTICIPANTS Mean Rank Rank Order  NONPARTICIPANTS Mean Rank Rank Order  Audio V i s u a l L e a r n i n g S t a t i o n i n the H o s p i t a l  2.81  1 ...  2  .'4.59  5  3.69  2  3.19  1  5.43  8  4.08  3  3.95  3  5.07  7  Hospital Library  4.14  4  4.45  4  2.46  1  L e c t u r e s , Seminars, e t c . Given by L o c a l Leaders  4.45  5  5.09  7.5  4.28  4  4.85  6  4.88  5  3.97  3  e t c . i n Larger Centres  5.04  7  4.95  6  3.32  2  Loan System f o r P r i n t Materials  5.98  8  5.09  7.5  4.88  6  Continued V i s i t s by the MIRC Lectures, Seminars, e t c . Given by Outside Leaders  \3>22  Loan System f o r ; •• • . Audio V i s u a l ' Materials Conferences, Workshops,  87 A Spearman rank c o r r e l a t i o n c o e f f i c i e n t c a l c u l a t e d to t e s t the r e l a t i o n s h i p between the rank o r d e r i n g assigned means was not s t a t i s t i c a l l y nor was a Pearsonian assigned  significant  t o the  (r = -0.398, d . f . = 8);  c o r r e l a t i o n c a l c u l a t e d between the mean ranks  to each item  (r = -Q.,449,d.f. = 8, n . s . ) .  This i n d i c a t e s  t h a t the two groups were d i s s i m i l a r i n t h e i r p r e f e r e n c e s c a t i o n a l d e l i v e r y systems. vealed  f o r edu-  Indeed, comparing i n d i v i d u a l items r e -  important d i f f e r e n c e s . Understandably, continued  v i s i t s by the MIRC was the  approach most p r e f e r r e d by p a r t i c i p a n t s and l e a s t p r e f e r r e d by nonp a r t i c i p a n t s , probably  because p a r t i c i p a n t s , having made the de-  c i s i o n to p a r t i c i p a t e and having  i n v e s t e d time i n doing  so, tended  to be b i a s e d i n i t s f a v o r ; whereas n o n - p a r t i c i p a n t s had no b a s i s on which to form an o p i n i o n . pants  The second p r e f e r e n c e  of p a r t i c i -  (an a u d i o - v i s u a l l e a r n i n g s t a t i o n i n the h o s p i t a l ) was the  f i f t h c ho ic e o f n o n - p a r t i c i p a n t s .  This may be due i n p a r t t o the  f a c t that a s i g n i f i c a n t l y greater proportion of non-participants were employed o u t s i d e a h o s p i t a l and t h e r e f o r e would n o t f i n d i t convenient  t o use a l e a r n i n g s t a t i o n l o c a t e d t h e r e .  t h i r d preference for  However, the  o f n o n - p a r t i c i p a n t s was a loan system  a u d i o - v i s u a l m a t e r i a l s , i n d i c a t i n g some i n t e r e s t i n u s i n g  media f o r l e a r n i n g .  The f i r s t c h o i c e o f n o n - p a r t i c i p a n t s  p i t a l l i b r a r y ) was f o u r t h p r e f e r e n c e  (a hos-  of p a r t i c i p a n t s , a r e s u l t  c o n s i s t e n t w i t h the f i n d i n g r e p o r t e d e a r l i e r t h a t n o n - p a r t i c i p a n t s tended t o read a g r e a t e r number o f books.  The second  preference  88  of non-participants (conferences and workshops in larger centres) was the sixth choice of participants. Because a greater proportion 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 percen 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 respond. 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.  89  TABLE XXI PERCENTAGE DISTRIBUTION OF REASONS FOR NOT PARTICIPATING IN THE MIRC PROJECT  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 o f my l e i s u r e time  25  18.38  I was away on h o l i d a y s  22  16.18  Community r e s p o n s i b i l i t i e s took up too much o f my l e i s u r e time  3.68  The MIRC was not a t a convenient l o c a t i o n  1.47  The hours o f MIRC o p e r a t i o n were not convenient  1.47  Other reasons  10  7.35  No response  37  27.21  136  100.00  TOTALS  90 SUMMARY The  majority  of the respondents were married females  tween the ages of 26 and  49, who  as nurses i n a h o s p i t a l .  were employed on a f u l l - t i m e  They had  g r a d u a t i o n f o r an average of 10.8 during  during  the  same p e r i o d .  audio v i s u a l media f o r There were no pants and and  y e a r s , had  read an  on the b a s i s of age,  marital  p r o f e s s i o n a l e d u c a t i o n ; but  of  l e a r n i n g to approximately the  a  signifiof  non-  read approximately the same  journals  and  same e x t e n t .  had  used media f o r  However,  read s i g n i f i c a n t l y more books.  The  nontwo  not d i f f e r s i g n i f i c a n t l y on the b a s i s of employment  number of years of p r a c t i c e s i n c e g r a d u a t i o n and p r a c t i c e since graduation.  status,  of p a r t i c i p a n t s were female and  number of i s s u e s of p r o f e s s i o n a l  groups status,  continuity  of  However, a s i g n i f i c a n t l y h i g h propor-  t i o n o f p a r t i c i p a n t s were pharmacists, and physiotherapists  s i g n i f i c a n t l y higher proportion a h o s p i t a l , and  journals  made r e l a t i v e l y l i t t l e use  Both groups had  were d e n t i s t s , d o c t o r s ,  average  s i g n i f i c a n t d i f f e r e n c e s between p a r t i c i -  proportion  p a r t i c i p a n t s had  had  workshops  learning.  l o c a t i o n of most recent  p a r t i c i p a n t s male.  and  basis  since  attended two  17 i s s u e s of p r o f e s s i o n a l  They had  non-participants  cantly greater  did  p r a c t i c e d continuously  the year p r i o r to the MIRC's v i s i t ,  of s i x p r o f e s s i o n a l books and  be-  non-participants  of  and  non-participants s o c i a l workers.  A  o f p a r t i c i p a n t s were employed i n in private  practice.  91  On the whole , participants reactions to the MIRC project appear to have been favorable, although there were differen 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 severa 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 som 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 fo continuing education indicated that an audio visual learning stati in a hospital was preferred, that continued visits by the MIRC was second, and that a loan system for print materials was least 1  92 preferred.  The  rank o r d e r i n g s assigned by p a r t i c i p a n t s and  p a r t i c i p a n t s were not s i g n i f i c a n t l y r e l a t e d .  non-  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  their f i r s t  L e c t u r e s , seminars, e t c . by l o c a l l e a d e r s and p r i n t m a t e r i a l s were l e a s t p r e f e r r e d .  choice.  a loan system f o r  Non-participants,  however,  p r e f e r r e d u s i n g a h o s p i t a l l i b r a r y or a t t e n d i n g conferences workshops i n l a r g e r c e n t r e s .  Continued v i s i t s by the MIRC  or was  t h e i r l e a s t p r e f e r r e d approach. The m a j o r i t y of n o n - p a r t i c i p a n t s c i t e d a demanding work schedule,  f a m i l y r e s p o n s i b i l i t i e s , or h o l i d a y s as reasons f o r not  participating.  Very few gave reasons t h a t suggested ways i n which  the p r o j e c t could be a l t e r e d 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 o f t h i s study was t o d e s c r i b e t h e P.A. Wood-  ward Mobile I n s t r u c t i o n a l Resource Centre P r o j e c t and t o analyze i t s r o l e i n c o n t i n u i n g p r o f e s s i o n a l education for  i n the health  those r e s i d e n t i n i s o l a t e d r u r a l areas i n B r i t i s h Data were obtained  field  Columbia.  on the demographic and employment  c h a r a c t e r i s t i c s , c o n t i n u i n g education  a c t i v i t i e s , and r e a c t i o n s  to the p r o j e c t o f 521 p a r t i c i p a n t s i n 11 p r o f e s s i o n a l c a t e g o r i e s , r e s i d e n t 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  c o n t i n u i n g education  activities,  on the c h a r a c t e r i s t i c s ,  and the reasons f o r non-  p a r t i c i p a t i o n o f 136 (40.8%) o f 333 n o n - p a r t i c i p a n t s  i n seven  professional categories. The  P.A. Woodward Mobile I n s t r u c t i o n a l Resource Centre  P r o j e c t was one o f a number o f d e l i v e r y systems used by the D i v i sion o f Continuing  Education  i n the H e a l t h  v e r s i t y o f B r i t i s h Columbia t o provide  Sciences  a t the  Uni-  learning opportunities for  r u r a l h e a l t h p r o f e s s i o n a l s i n t h e i r home communities d u r i n g the e a r l y 1970's.  The c e n t r a l f e a t u r e o f the p r o j e c t was a highway bus  t h a t had been converted  i n t o a mobile c o n t i n u i n g education  facility  c o n t a i n i n g three audio v i s u a l l e a r n i n g s t a t i o n s and over 1300 audio  v i s u a l programs.  The MIRC spent a s i x t y - h o u r week a t the h o s p i t a l  i n each community v i s i t e d .  The p r o j e c t was s u p e r v i s e d by an i n t e r -  p r o f e s s i o n a l committee i n the D i v i s i o n o f C o n t i n u i n g the Health Sciences  and was operated  was a graduate student  i n adult  Education i n  by a f i e l d s u p e r v i s o r who  education.  A t o t a l o f 521 h e a l t h p r a c t i t i o n e r s i n 11 p r o f e s s i o n a l c a t e g o r i e s , r e p r e s e n t i n g approximately 41 percent  o f the p o t e n t i a l  p a r t i c i p a n t s , took p a r t i n the MIRC p r o j e c t d u r i n g the p e r i o d concerned.  P a r t i c i p a t i o n r a t e s were s i g n i f i c a n t l y h i g h e r among pro-  f e s s i o n s f o r whom the D i v i s i o n r e g u l a r l y provided  o t h e r forms o f  l e a r n i n g o p p o r t u n i t i e s than among those f o r whom i t d i d not, and higher  t o a degree t h a t tended toward s i g n i f i c a n c e among p r o f e s -  s i o n s employed o u t s i d e a h o s p i t a l than among h o s p i t a l - b a s e d fessions.  pro-  P a r t i c i p a t i o n r a t e s were n o t s i g n i f i c a n t l y r e l a t e d t o  the d i s t a n c e o f communities from Vancouver e i t h e r i n terms o f m i l e s or t r a v e l time, b u t were n e g a t i v e l y r e l a t e d t o t h e s i z e o f the local hospitals.  Rates i n communities w i t h h o s p i t a l s having 40  beds o r 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 p e r i o d , a t o t a l o f 2474 B r i t i s h h e a l t h p r o f e s s i o n a l s from s i x p r o f e s s i o n s , r e p r e s e n t i n g mately 15 percent  Columbia  approxi-  o f the p o t e n t i a l p a r t i c i p a n t s , took p a r t i n 7 5  s h o r t courses and workshops conducted by the D i v i s i o n . For the s i x p r o f e s s i o n s normally  served by the r e g u l a r  programming o f the D i v i s i o n , t h e o v e r - a l l p a r t i c i p a t i o n r a t e i n  95 the MIRC p r o j e c t was. s i g n i f i c a n t l y h i g h e r than the o v e r - a l l r a t e f o r other D i v i s i o n a c t i v i t i e s , as were the r a t e s f o r pharmacy, and r e h a b i l i t a t i o n m e d i c i n e . f o r the other three p r o f e s s i o n s  nursing,  The d i f f e r e n c e s i n r a t e s  were n o t s t a t i s t i c a l l y s i g n i f i c a n t .  L i m i t i n g the comparison t o h e a l t h p r o f e s s i o n a l from those communities served by the MIRC p r o j e c t , 101 o f 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 p r o j e c t , i t was found that the o v e r - a l l r a t e f o r D i v i s i o n a c t i v i t i e s o f other types was s i g n i f i c a n t l y lower than t h e r a t e f o r the MIRC p r o j e c t and  t h a t the same was true f o r four p r o f e s s i o n a l groups:  nursing,  pharmacy and r e h a b i l i t a t i o n medicine.  dietetics,  There was no s i g n i -  f i c a n t d i f f e r e n c e f o r d e n t i s t r y and medicine. Making the comparison on the b a s i s o f i n d i v i d u a l communities,  i t was found that p a r t i c i p a t i o n r a t e s i n the MIRC p r o j e c t  were s i g n i f i c a n t l y h i g h e r than r a t e s i n other D i v i s i o n programs f o r a l l b u t one o f the communities v i s i t e d by the MIRC. On  the whole, i t appears t h a t the MIRC p r o j e c t served a  d i f f e r e n t s e t o f i n d i v i d u a l s than d i d o t h e r D i v i s i o n programs. a combined t o t a l o f 443 p a r t i c i p a n t s from c o m m u n i t i e s c v i s i t e d the MIRC, only  by  50 (11.3%) p a r t i c i p a t e d both i n the MIRC p r o j e c t and  at l e a s t one other D i v i s i o n a c t i v i t y . cipants  Of  The number o f common p a r t i -  i n most l o c a t i o n s was l e s s than 10 p e r c e n t o f the t o t a l  number from t h a t l o c a t i o n . number o f p r o f e s s i o n s provide learning  Moreover, the MIRC p r o j e c t served a  f o r whom the D i v i s i o n d i d not o r d i n a r i l y  opportunities.  96 The  c o s t of o p e r a t i n g the MIRC p r o j e c t d u r i n g the p e r i o d  concerned was  $42,500.28 compared to $159,518.64 f o r o t h e r  s i o n programs.  On  the b a s i s o f the  Divi-  cost-per-participant-hour-of-  i n s t r u c t i o n , the c o s t o f the MIRC p r o j e c t  ($16.44) was  approxi-  mately f o u r times as high as the e q u i v a l e n t c o s t f o r other sion a c t i v i t i e s  ($3.89).  were not a v a i l a b l e and  Costs to p a r t i c i p a n t s and  their  Diviemployers  t h e r e f o r e were not i n c l u d e d i n the c a l c u -  lations . The m a j o r i t y of the 657 obtained  i n the MIRC p r o j e c t were married  ages of 26 and in a hospital. education  49 who  females between the  were employed on a f u l l - t i m e b a s i s as nurses  They had  obtained  t h e i r most r e c e n t p r o f e s s i o n a l  i n B r i t i s h Columbia or another Canadian p r o v i n c e  practiced continuously graduation. attended  respondents from whom data were  had  f o r a p e r i o d of 15 years or l e s s s i n c e  During the year p r i o r to the MIRC's v i s i t ,  an average of two workshops, and had  s i x p r o f e s s i o n a l books and  they  had  read an average of  17 i s s u e s of p r o f e s s i o n a l j o u r n a l s .  When p a r t i c i p a n t s and the b a s i s of demographic and t i n u i n g education  and  n o n - p a r t i c i p a n t s were compared  employment c h a r a c t e r i s t i c s and  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  d i f f e r e n c e s 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  on  con-  significant  proportion  of p a r t i c i p a n t s were female w h i l e more n o n - p a r t i c i p a n t s were male. A s i g n i f i c a n t l y : h i g h e r .proportion o f - p a r t i c i p a n t s were pharmacists w h i l e more n o n - p a r t i c i p a n t s were d e n t i s t s , d o c t o r s , and  s o c i a l workers.  physiotherapists,  A s i g n i f i c a n t l y higher p r o p o r t i o n of  partici-  97 pants were employed i n a h o s p i t a l , and n o n - p a r t i c i p a n t s practice. The  i n private  N o n - p a r t i c i p a n t s had read s i g n i f i c a n t l y more books.  two groups d i d 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 appear t o have been f a v o r a b l e  1  reactions  to .the  project  as measured by a f i v e p o i n t  reaction  s c a l e on which the mean r e a c t i o n score f o r a l l items was between 4.1 and 4.4.  Significant differences  encountered among the v a r i o u s  p r o f e s s i o n a l groups appear t o be a t t r i b u t e d t o the l o c a t i o n o f employment and the l a c k o f p r o f e s s i o n - s p e c i f i c m a t e r i a l s groups. various  f o r some  S i g n i f i c a n t d i f f e r e n c e s were a l s o encountered among the communities on a l l items.  negatively  D i s t a n c e from Vancouver was  r e l a t e d to r e a c t i o n scores on three items, i n d i c a t i n g  t h a t respondents i n communities nearer Vancouver l i k e d those a s pects o f the p r o j e c t b e t t e r than d i d those l i v i n g f a r t h e r away. This r e s u l t may have been due i n p a r t t o e f f e c t s o f the i n e x p e r i e n c e of the f i e l d s u p e r v i s o r s the most remote.  i n the f i r s t  Other f a c t o r s which may have accounted f o r d i f -  ferences on some o f the items are: continuing  few communities, which were  a possible  lack of i n t e r e s t i n  e d u c a t i o n i n some communities; the l a c k o f p r o f e s s i o n -  s p e c i f i c materials  f o r c e r t a i n groups; the d i f f i c u l t y o f coping  w i t h l a r g e numbers o f l e a r n e r s  i n the l e a r n i n g environment a t one  time; and the l o c a t i o n o f the MIRC i n terms o f i t s v i s i b i l i t y and accessibility.  98 Respondents' rankings systems f o r c o n t i n u i n g education  of e i g h t a l t e r n a t i v e d e l i v e r y i n d i c a t e d t h a t an a u d i o - v i s u a l  l e a r n i n g s t a t i o n i n a h o s p i t a l was  preferred, that  v i s i t s by the MIRC was  that a l o a n system  second, and  f o r p r i n t m a t e r i a l s was  least preferred.  continued  The rank o r d e r i n g s  signed by p a r t i c i p a n t s and n o n - p a r t i c i p a n t s were not related.  P a r t i c i p a n t s ' f i r s t c h o i c e was  continued  as-  significantly  v i s i t s by  the  MIRC, which were l e a s t p r e f e r r e d by n o n - p a r t i c i p a n t s , whose f i r s t c h o ic e was was  using a h o s p i t a l l i b r a r y .  P a r t i c i p a n t s ' second  choice  an a u d i o - v i s u a l l e a r n i n g s t a t i o n i n a h o s p i t a l , whereas ..the  second c ho ic e of n o n - p a r t i c i p a n t s was larger centres.  conferences  and workshops i n  N e i t h e r group favored a loan system f o r p r i n t  materials. The m a j o r i t y of n o n - p a r t i c i p a n t s c i t e d p r a c t i c a l blems such as demanding work schedules, and  absence due  Very few  pro-  family r e s p o n s i b i l i t i e s  to h o l i d a y s as reasons f o r not  participating.  gave reasons t h a t suggested ways i n which the p r o j e c t  c o u l d be a l t e r e d to improve p a r t i c i p a t i o n . CONCLUSIONS The Mobile  I n s t r u c t i o n a l Resource Centre appears to be  an e f f e c t i v e system f o r d e l i v e r i n g c o n t i n u i n g education  to r u r a l  h e a l t h p r o f e s s i o n a l s because p a r t i c i p a t i o n r a t e s f o r most p r o f e s s i o n a l groups and  i n most communities were h i g h e r  than r a t e s i n  other programs p r o v i d e d d u r i n g the same p e r i o d , and because i t  99  reached a substantial number of professionals not reached by th other programs. It also appears to be a system that is accepta to the people it is intended to serve because the reactions of most of the participants to the project were favorable. Altho it is more expensive than other delivery systems when only cost 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 potentia economical system to deliver continuing education in the health sciences to rural areas. IMPLICATIONS FOR CONTINUING EDUCATIONOn the basis of this study's findings, an audio-visua 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 tri basis in a number of hospitals and a study made of their uti tion. To be effective, however, this approach must be support by a centralized loan system for audio-visual materials and by properly-trained technicians,to service the equipment and material 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 materi and appropriate periodicals. Learning stations should be located in or near the libraries and be supplemented by articles and  100 relevant reference material.  .  In order to p r o v i d e the necessary  support systems f o r  the l i b r a r i e s and l e a r n i n g s t a t i o n s i n the l o c a l h o s p i t a l s , a l e a r n i n g resources network i s necessary  t o l i n k the r e g i o n a l hos-  p i t a l s o r the community c o l l e g e s with a major c e n t r a l  resource  c e n t r e , p o s s i b l y the B i o - M e d i c a l L i b r a r y a t the U n i v e r s i t y o f British  Columbia. N o n - p a r t i c i p a n t s expressed  an i n t e r e s t i n a l o a n system  f o r audio v i s u a l m a t e r i a l s t o be used o u t s i d e the l o c a l Such a system c o u l d be operated through  hospital.  from the h o s p i t a l l i b r a r y o r  the l e a r n i n g resources network.  Before t h i s i s encouraged,  c r i t e r i a should be e s t a b l i s h e d t o ensure t h a t formats  f o r audio  v i s u a l n m a t e r i a l s a r e s t a n d a r d i z e d and compatible w i t h  easily  a c c e s s i b l e and inexpensive playback  equipment.  Topical materials for hospital l i b r a r i e s ,  learning sta-  t i o n s and l e a r n i n g resources network c o u l d be determined of ways:  i n a num-  1) a n a l y s i s o f the t o p i c s o f programs used i n the MIRC;  2) a n a l y s i s o f e p i d e m i o l o g i c a l d a t a ; 3) a n a l y s i s by r e g i o n o f the r e s u l t s o f s e l f - a s s e s s m e n t t e s t s conducted  by p r o f e s s i o n a l j o u r -  n a l s ; 4) w r i t t e n s i m u l a t i o n s and s e l f - a s s e s s m e n t t e s t s  developed  by the D i v i s i o n o f C o n t i n u i n g Education i n the Health Sciences a t the U n i v e r s i t y o f B r i t i s h  Columbia.  Because the p a r t i c i p a n t s i n the MIRC and other programs i n t h i s study r e p r e s e n t e d l e s s than 50 percent o f the p o t e n t i a l c l i e n t e l e , other d i s t a n c e education systems should be i n v e s t i g a t e d . The  f i r s t step should be to f i n d out who the p o t e n t i a l  participants  101 are  C p r o f e s s i o n , s p e c i a l t y , e t c . ) , where they are l o c a t e d , what  types of c o n t i n u i n g e d u c a t i o n a c t i v i t i e s p r e s e n t , which they p r e f e r , why  they p a r t i c i p a t e i n at  they d i d not appear i n any of the  f a c e t s of t h i s study, and other r e l e v a n t i n f o r m a t i o n . mation w i l l  This  form a b a s i s f o r s e l e c t i n g other approaches.  The MIRC p r o j e c t suggests  that l e a r n i n g opportunities  o f f e r e d 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 l a r g e r  p r o p o r t i o n of the p o t e n t i a l p a r t i c i p a n t s than those o f f e r e d where.  infor-  else-  Examples with s t r o n g p o t e n t i a l f o r B r i t i s h Columbia a r e : 1.  E d u c a t i o n a l experiences planned  and o r g a n i z e d by  a p p r o p r i a t e l y t r a i n e d l o c a l c o - o r d i n a t o r s such as the network of c o - o r d i n a t o r s a s s o c i a t e d w i t h the D i v i s i o n of C o n t i n u i n g Pharmacy Education at the U n i v e r s i t y of B r i t i s h Columbia. network p l a n and conduct 2. education  Members of the  programs f o r t h e i r c o l l e a g u e s .  Off-campus courses and workshops planned by major  institutions. 3.  Two-way audio and v i d e o t e l e v i s i o n l i n k s  r u r a l communities w i t h major c e n t r e s .  connecting  Because of the mountainous  t e r r a i n , s a t e l l i t e . : t r a n s m i s s i o n would be more a p p r o p r i a t e than micro-wave t r a n s m i s s i o n i n B r i t i s h Columbia.  The p r e s e n t Hermes  s a t e l l i t e i s s u i t a b l e f o r t h i s purpose on a short-term 4.  Telephone d i a l access systems and  basis.  telephone  consul-  t a t i o n s e r v i c e s to p r o v i d e a s s i s t a n c e w i t h s p e c i f i c p a t i e n t management problems.  However, w h i l e these s e r v i c e s have been w e l l -  r e c e i v e d elsewhere,  the p r i n c i p l e u s e r s :  nurses, d o c t o r s , d e n t i s t s  102 and pharmacists, have not always been w i l l i n g t o support of  the c o s t s  operation. 5.  Telephone conference systems.  However, l o c a t i o n s  i n which these have been s u c c e s s f u l have not been as mountainous as B r i t i s h Columbia and t h e r e f o r e higher c o s t s o f e s t a b l i s h i n g s u i t able telephone l i n k a g e s may make them l e s s f e a s i b l e i n t h i s  province.  IMPLICATIONS FOR THE MIRC PROJECT Because o f the high p a r t i c i p a t i o n r a t e s and the f a v o r able r e a c t i o n s o f p a r t i c i p a n t s , i t seems a p p r o p r i a t e  t o continue  the p r o j e c t . The  present v e h i c l e , which has s e r i o u s mechanical  blems, should be r e p l a c e d with a t r a c t o r - t r a i l e r T h i s would allow the f i e l d trailer  pro-  combination.  s u p e r v i s o r t o t r a v e l independent o f the  u n i t when r e q u i r e d . Because o f the problems o f p r o v i d i n g e d u c a t i o n a l  acti-  v i t i e s f o r d i s t a n t l e a r n e r s , the p r i n c i p a l o b j e c t i v e s o f the proj e c t should be 1) to s t i m u l a t e i n t e r e s t i n the use o f i n s t r u c t i o n a l media f o r independent l e a r n i n g , and 2) to a s s i s t w i t h ment o f l o c a l c o n t i n u i n g education  resources.  The MIRC should be s t a f f e d by two f i e l d t r a i n e d i n a d u l t education ject.  the develop-  supervisors  and other matters r e l a t e d to the pro-  T h i s would 1) permit maximizing the hours of o p e r a t i o n  out i n c r e a s i n g the load on a s i n g l e f i e l d the f i e l d  with-  s u p e r v i s o r ; and 2) allow  s u p e r v i s o r s to l e a d and develop l o c a l d i s c u s s i o n groups,  103 and work with, l o c a l educators  (.co-ordinators o f C o n t i n u i n g Phar-  macy E d u c a t i o n , i n - s e r v i c e educators, chairmen o f medical committees, etc.) on matters p e r t i n e n t t o t h e i r  education  interests.  The present p o l i c y o f g i v i n g p r e f e r e n c e t o s m a l l e r hosp i t a l s should be continued.  However, to a f f o r d maximum o p p o r t u n i t y  f o r p a r t i c i p a t i o n , the l e n g t h o f v i s i t s should be r e l a t e d to the s i z e o f the h o s p i t a l , w i t h no l e s s than f i v e days b e i n g spent i n any l o c a t i o n and a maximum o f 10 days i n l o c a t i o n s w i t h h o s p i t a l s up t o 100 beds i n s i z e .  Because o f space  l i m i t a t i o n s i n the MIRC,  no community w i t h a h o s p i t a l l a r g e r 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 h o l d i n g s should be expanded t o i n c l u d e m a t e r i a l s f o r a l l p r o f e s s i o n s the p r o j e c t i s intended to serve. At p r e s e n t , the m a j o r i t y o f the programs a r e intended f o r d o c t o r s , nurses, d e n t i s t s and pharmacists.  Because personnel i n s m a l l hos-  p i t a l s form c l o s e - k n i t communities, i t seems a p p r o p r i a t e to prov i d e m a t e r i a l s f o r a l l workers d e l i v e r i n g d i r e c t p a t i e n t c a r e . This means t h a t programs f o r d i e t i t i a n s , m e d i c a l l a b o r a t o r y t e c h n o l o g i s t s , medical records l i b r a r i a n s , o c c u p a t i o n a l t h e r a p i s t s , p h y s i o t h e r a p i s t s , X-ray be added.  t e c h n i c i a n s and ambulance attendants should  Space l i m i t a t i o n s i n the v e h i c l e may make i t inappro-  p r i a t e t o t r y to i n c l u d e i n s t i t u t i o n a l support keeping, maintenance, laundry, e t c . ) . p i t a l c o u l d be planned  personnel?;-.(house-  Group s e s s i o n s i n the hos-  f o r them.  A l e n d i n g l i b r a r y o f p r i n t m a t e r i a l s should augment the  104 h o l d i n g s t o provide o p p o r t u n i t y f o r i n depth study o f s e l e c t e d topics. The  second phase o f the p r o j e c t should i n v o l v e a change  i n focus w i t h comprehensive treatments o f s p e c i a l i z e d areas r e p l a c i n g the present g e n e r a l i n t r o d u c t i o n t o i n s t r u c t i o n a l media. Topics i n demand a t the present time are cardio-pulmonary  resus-  c i t a t i o n and the management o f p a i n .  One f i e l d s u p e r v i s o r should  be a content expert who c o u l d conduct  l e a r n i n g experiences f o r  h e a l t h p r o f e s s i o n a l s and the p u b l i c w h i l e audio v i s u a l  treatments  of the t o p i c were a v a i l a b l e i n the MIRC. I f the MIRC p r o j e c t cannot  continue i n i t s present form,  the c a r r e l s , equipment and m a t e r i a l s should be used  to e s t a b l i s h  a p i l o t p r o j e c t w i t h l e a r n i n g s t a t i o n s l o c a t e d i n three h o s p i t a l s . P o s s i b l e l o c a t i o n s a r e A l e r t Bay, Enderby and L i l l o o e t , which a r e t y p i c a l o f h o s p i t a l s the p r o j e c t was intended t o serve because o f t h e i r s m a l l s i z e and remoteness from Vancouver.  I f t h i s i s not  f e a s i b l e , the m a t e r i a l s should become p a r t o f a l o a n system operated out o f the D i v i s i o n of B i o m e d i c a l Communications o r the Woodward B i o - M e d i c a l L i b r a r y . IMPLICATIONS FOR FURTHER STUDY The f o l l o w i n g aspects o f the p r o j e c t appear to warrant further  study: 1.  The a b i l i t y o f the p r o j e c t to s t i m u l a t e i n t e r e s t i n  c o n t i n u i n g education and i n the use o f media f o r independent  learn-  105 i n g should be s t u d i e d by g a t h e r i n g  data on the c o n t i n u i n g  educa-  t i o n h a b i t s and p r e f e r e n c e s o f p a r t i c i p a n t s p r i o r to and a t an appropriate  i n t e r v a l f o l l o w i n g t h e i r p a r t i c i p a t i o n i n the p r o j e c t .  This would help determine whether p a r t i c i p a t i n g i n the MIRC p r o ject contributed 2.  to any change.  A more complete study o f the c o s t s o f the p r o j e c t  i n c l u d i n g c o s t s t o p a r t i c i p a n t s and employers, and the u t i l i z a t i o n of p r o f e s s i o n a l manpower, compared w i t h s i m i l a r c o s t s  f o r other  d e l i v e r y systems would be v a l u a b l e . 3.  The impact o f p a r t i c i p a t i n g i n the p r o j e c t on the  p a r t i c i p a n t s ' p r a c t i c e should be s t u d i e d . 4.  A study should be conducted t o determine the accept-  a b i l i t y , e f f e c t i v e n e s s and economic f e a s i b i l i t y o f l e a r n i n g s t a t i o n s i n l o c a l h o s p i t a l s r e f e r r e d to i n the p r e v i o u s 5. and  sections.  The degree o f a s s o c i a t i o n between p a r t i c i p a t i o n r a t e s  the s i z e o f communities should be t e s t e d again when the l e n g t h  of v i s i t s has been adjusted  to r e l a t e t o the s i z e o f the l o c a l  hospital. 6. and  The degree o f a s s o c i a t i o n between p a r t i c i p a t i o n r a t e s  the d i s t a n c e  centres  o f communities from major c o n t i n u i n g  education  should be t e s t e d again when a l a r g e r number o f communities  over a wider geographic area have been v i s i t e d and when a procedure has  been d e r i v e d  f o r i n c l u d i n g other c o n t i n u i n g  education  centres  i n a d d i t i o n to Vancouver i n the c a l c u l a t i o n . 7.  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" P h y s i c i a n and H o s p i t a l C h a r a c t e r i s t i c s A s s o c i a t e d With The Use Of M e d i c a l T e l e v i s i o n . " Journal of M e d i c a l E d u c a t i o n . 47:139-41 (Feb. 1972).  41.  Hunter, J . e t a l . "Medical E d u c a t i o n a l T e l e v i s i o n Survey." Journal of Medical Education. 47:57-63 (Jan. 1972).  42.  Hunter, W.S. "CNIB Mobile M e d i c a l Eye Care U n i t s In Canada: O n t a r i o Mobile Eye Care U n i t . " Canadian J o u r n a l o f Ophthalmology. 10:342-3 (July 1975).  43.  Johnson, G.R. "Continuing Education Through Chapter Activities." P h y s i c a l Therapy. 46:46-9 (Jan. 1966).  44.  Jones, W.A. "The Study Club as a Means o f C o n t i n u i n g Education." J o u r n a l o f the Canadian Dental A s s o c i a t i o n . 42:589-90 (Dec. 1976) .  45.  Knowles, M.S. The A d u l t Education Movement i n the U n i t e d States. H o l t , Rinehart and Winston, I n c . (New York 1962).  46.  La Fontan, L . J . "An Approach t o ICU Nurse E d u c a t i o n i n a Small Rural Community H o s p i t a l . " J o u r n a l o f C o n t i n u i n g Education i n Nursing. 2:32-7 (Sept. - Oct. 1971).  47.  L l o y d , J.S. "State R e g u l a t i o n o f Health P r o f e s s i o n a l s . " H o s p i t a l Progress. 51:70-4 (Mar. 1970).  48.  MacBain, P. "OT's on Wheels." Canadian J o u r n a l o f Occupat i o n a l Therapy. 37:63-8 (Summer 1970).  49.  Mackenzie, 0. "Status and Trends of Correspondence I n s t r u c t i o n i n the U n i t e d S t a t e s . " i n The Changing World of Correspondence Study., e d i t e d by 0. Mackenzie and E. C h r i s t e n s e n . The Pennsylvania State U n i v e r s i t y Press ( U n i v e r s i t y Park and London, 1971) p.p. 356-74.  50.  Manual o f C o n t i n u i n g Education i n the Health S c i e n c e s . D i v i s i o n o f 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 , H e a l t h Sciences Centre, U n i v e r s i t y o f B r i t i s h Columbia ( r e v i s e d Apr. 1977).  Ill  51.  M e l r o s e , R.J. e t a l . " E x p e r i e n c e 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 E d u c a t i o n . " Journal of Dental Education. 40:150-3 (Mar. 1 9 7 6 ) .  52.  M r t e k , M.B. and R.G. M r t e k . "The P o t e n t i a l o f Programmed Review M a t e r i a l s i n C o n t i n u i n g E d u c a t i o n . " American Journal of Pharmaceutical Education. 35:211-15 (1971).  53.  Nakamoto, J . and C. V e r n e r . 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 P r o f e s s i o n s - A Review o f t h e L i t e r a t u r e P e r t i n e n t to North America: 1960-1970. Eric Clearinghouse on A d u l t E d u c a t i o n ( S y r a c u s e 1 9 7 3 ) .  54.  Neu,  55.  "A New A p p r o a c h t o C o n t i n u i n g E d u c a t i o n . " American o f H o s p i t a l Pharmacy. 28:597 (Aug. 1 9 7 1 ) .  56.  N e y l a n , M. M a i n t a i n i n g t h e Competence o f H e a l t h 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 Continuing 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.  N e y l a n , M. e t a l . "An I n t e r p r o f e s s i o n a l A p p r o a c h t o Cont 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 . " The J o u r n a l of Continuing Education i n Nursing. 2:21-8 ( J u l y - Aug. 1971).  58.  O a k l e y , C.L. "The F i r s t Twenty Y e a r s o f A u d i o - D i g e s t . " C a l i f o r n i a Medicine. 116:81-8 (June 1 9 7 2 ) .  59.  P.A.  Woodward H e a l t h S c i e n c e s I n f o r m a t i o n S e r v i c e . Division 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 M o b i l e I n s t r u c t i o n a l R e s o u r c e C e n t r e . " N a t i o n a l Health Grant Submission of P r o j e c t . Division 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 S c i e n c e s C e n t r e , U n i v e r s i t y o f B r i t i s h C o l u m b i a , (Dec. 1971) .  61.  H.C. " S e l f A s s e s s m e n t and L e a r n i n g V i a V i d e o t a p e . " New E n g l a n d J o u r n a l o f M e d i c i n e . 293:1291-5 (Dec. 18, 1975) . Journal  P e a r s o n , K.M. Jr. " D i a l Access L i b r a r i e s : T h e i r Use and Utility." Journal of Medical Education. 49:882-96 ( S e p t . 1974) .  7,  "Programmed I n s t r u c t i o n : P a t i e n t Assessment: Examination of of the Ear." American J o u r n a l o f Nursing. 3:Suppl. (Mar. 1975). R o l l c a l l ; A Status Report o f H e a l t h Personnel i n the P r o v i n c e of B r i t i s h Columbia. O f f i c e o f the C o - o r d i n a t o r , H e a l t h Sciences Centre, U n i v e r s i t y o f B r i t i s h Columbia, Vancouver (19 74). Rosser, W.W. "A N a t i o n a l S e l f - E v a l u a t i o n Program f o r Canadian Family Doctors." Canadian M e d i c a l A s s o c i a t i o n Journal. 112:982-6 (Apr. 19, 1975). Second Annual Report 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 Sciences 1969-70. D i v i s i o n o f 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 , H e a l t h Sciences Centre, U n i v e r s i t y of B r i t i s h Columbia (Oct. 1970). "The  Self-Assessment and C o n t i n u i n g E d u c a t i o n Program. Some Comments by P a r t i c i p a n t s . " J o u r n a l o f the American C o l l e g e o f D e n t i s t s . 40:207 (Oct. 1973).  " S e l f - E v a l u a t i o n Program." 22:71-75 (Nov. 1976) .  Canadian Family P h y s i c i a n .  "75th Annual Report on M e d i c a l E d u c a t i o n i n the U n i t e d S t a t e s : 1975-76." J o u r n a l o f the American M e d i c a l A s s o c i a t i o n . 236 (Dec. 27, 1976). S i l v e r s t o n , S.E. and R.H. Hansen. "The Role o f Technology i n an E v o l v i n g C o n t i n u i n g E d u c a t i o n Program f o r H e a l t h Professionals." M e d i c a l Progress Technology. 1:187-95 (Feb. 1973). Sinnema, M.J. "Cassettes and A b s t r a c t s Form Agenda o f Monthly Club." J o u r n a l o f the American D i e t e t i c A s s o c i a t i o n . 63:277-8 (Sept. 1973). Spears, M.C. e t a l . " T e l e l e c t u r e s vs Workshops i n C o n t i n u i n g Education." J o u r n a l o f the American D i e t e t i c A s s o c i a t i o n . 63:239-47 (Sept. 1973). S p i c e r , M.R. " T r a v e l l i n g Teacher." Journal of Continuing Education i n Nursing. 6:17-21 (Nov. - Dec. 1975). STATISTICS CANADA. P o p u l a t i o n : Census D i v i s i o n s and Subd i v i s i o n s (Western P r o v i n c e s ) . V o l . 1, P a r t 1:1-7 (Ottawa, Oct. 1972). Strauch, G.O. " S u r g i c a l L e a r n i n g In Community H o s p i t a l s 1975." C o n n e c t i c u t M e d i c i n e . 39:543 (Sept. 1975).  113  75. StuarR te ,licCe .Tn.sure"Main ndat o r y Cgontanidnuitn g IEmdpulciactaitoinonsforfor N u r s i n h e H dg u. cat6 i: o2 n5 ."29Jou(rSneaplt.of-CoOct. ntinui1n9g75) E. ducation inighNeurrsiEn 76. Summar o Activities: S e p t e m b e r 1st, 19i7o3n -inAtuhgeust 31tsht, 1Sy 9ci7e4n .f Division o f C o n t i n u i n g E d u c a t H e a l ci ea s, , H(Fall ealth1-974S)ci. ences Centre, University of British Columb 77. "Teleconferences: A New Idea in Continuing Education." Texas Medicine. 71:104-6 (Sept. 1976). 78. ThirdMeAdnincuaall ER e p oarttion1 962 6 3 . DoefparMtemdeinctineo,f CHoenatlitnhuinSgciences d u c , F a c u l t y 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. VerneClassification r, C. A ConceOpftuParloceSscsheesmeForForAdTuhlet Identification and E d u c a t i o n . A dCu.lt19E6d2u)c.ation Association of the U.S.A. (Washington, D . 82. VerneI rn,terCn.ati"oFnuanldeasmenJtaahlrbuCcohn.cdeeprt-s in AednublitdunEgducation." in E r w a c h s tional(BYee b(yInJt.eHr.naKroll ra lr ib noo1k974)of.Adult Education), edited 83. "Video Cassette Education Program." Eye, Ear, Nose and Throat Monthly. 53:118-23 (May 1974). 84. WatkiE ndsu,catFi.o H.n eUtsial. " S o uthCircuit DakotaTelevision: ContinuingADe notal n g O p e n T w Yieoanr. R e p o r t . " J o u r n a l o f t h e A m e r i c a n D e n t a l A s s o c i a t 86 : 988 9.4 et(Maal. y 197 3 )N .D Regional Continuing Dental 85. WatkiE n s , F . H " M I dr ut ca tiW oe nstCou r s etsistVia Po5r2t:a3b7l0e-1Vid eoovt ap-e DCeocv era g e .3"). N o h D e n r y . ( N . . 1 9 7 86. WatkiC nosn,tinFu.i H.ng " M I N D -EduA Fiiovne."StJaotuernaRlegioo naD lent Aa pl proach to D e n t a l c a t f Education. 39:522-9 (Aug. 1975).  APPENDIX A Q u e s t i o n n a i r e For  Participants  Covering L e t t e r To N o n - P a r t i c i p a n t s Q u e s t i o n n a i r e For N o n - P a r t i c i p a n t s  Mobile I n s t r u c t i o n a l Resource Centre Questionnaire for P a r t i c i p a n t s  Name M a i l i n g Address  Phone  4^  Sex  (1) male  (2) female _  What i s your age? What i s your m a r i t a l  status?  (1) s i n g l e  (3) widowed, d i v o r c e d ,  (2) married  or  separated  (a) In what country d i d you  o b t a i n your p r o f e s s i o n a l  education? (b) I f i n Canada, what province? What i s your c u r r e n t health, p r o f e s s i o n or occupation? (1) D e n t i s t r y  (7) S o c i a l Work  (2) D i e t e t i c s  (8)  (3) Medicine (4) Nursing  • (RN)  LPN  (9) X-Ray  ______  (10) Med.  Lab.  (5) Rehab. Med.  (11) Med.  Library  (6) Pharmacy  (12)  Other (Specify)  ______  ' '  1  116 9.  What i s your f i e l d o f employment? (check one) a.  (1) h o s p i t a l (2) p u b l i c h e a l t h agency  (5) c h i l d w e l f a r e _  (6) mental h e a l t h (7) c o r r e c t i o n s  (3) p r i v a t e p r a c t i c e  (8) Other (Specify)  (4) p u b l i c w e l f a r e  b. I f you a r e employed by a h o s p i t a l , how many beds does i t have? 10.  Are you employed? (1) f u l l time (2) p a r t time (3) not a t present  11.  In what year d i d you graduate from the course t h a t gave you your p r o f e s s i o n a l q u a l i f i c a t i o n s ?  12.  How many years have you p r a c t i c e d s i n c e graduation? '  13.  Have you p r a c t i c e d each year s i n c e graduation?  (1) yes (.2) no  14.  How many years have you p r a c t i c e d i n B r i t i s h Columbia?  15.  What a r e your employment plans?  Do you i n t e n d t o :  (1) continue working u n t i l r e t i r e m e n t (2) stop working when you marry (3) stop working when you have a f a m i l y  117 (4) stop working  f o r an i n t e r v a l o f time f o r .  p e r s o n a l reasons b u t p l a n to r e t u r n to f u l l or  p a r t time employment  later  (5) undecided 16.  Approximately how many p r o f e s s i o n a l workshops, s h o r t courses, and conferences have you attended i n the p a s t year?  17.  (number)  Approximately how many p r o f e s s i o n a l books ( i n c l u d i n g r e f e r e n c e books) have-you read i n the past year? (number)  18.  Approximately how many i s s u e s o f p r o f e s s i o n a l s j o u r n a l s have you read i n the p a s t year? (number)  19.  Which o f the f o l l o w i n g a i d s t o l e a r n i n g have you used i n the past year? (i)  (check each  item)  tape r e c o r d e r :  ( i i )i ) vt i o s ltape: ad pei d e programme: (television  (2) no  (1) yes  (2) no  film)  (iv)  8 mm f i l m s or f i l m l o o p s :  (1) yes  (2) no  (v)  16 mm f i l m s :  (1) yes  (2) no  (1) yes  (.2) no  (vi) 20.  (1) yes  programmed i n s t r u c t i o n :  How d i d you f i r s t  hear about the M.I.R.C?  (check one) (1) l e t t e r from the h o s p i t a l (.2) telephone c a l l  from  hospital  118  21.  (3  informed i n person by someone i n a u t h o r i t y at the h o s p i t a l  (4  letter  (5  telephone c a l l from S o c i a l Work c o n t a c t person  (6  informed i n person by S o c i a l Work c o n t a c t person  (7  informed a t a meeting  (8  saw  (9  saw n o t i c e on h o s p i t a l b u l l e t i n  (10  t o l d by someone who had used i t  (11  saw M.I.R.C. b e s i d e h o s p i t a l  (12  read a r t i c l e i n l o c a l newspaper  (13  r e c e i v e d i n f o r m a t i o n from U.B.C.  (14  heard about i t on the r a d i o  (15  other  from S o c i a l Work c o n t a c t person  introductory tape-slide presentation board  (specify)  How many weeks ago d i d 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  Indicate,  youn. ie.e.llnQ&  about  qoix.fi lin&t  It by chzcklng  strongly agree 22.  M.I.R.C. p r o v i d e s a worthwhile opp o r t u n i t y f o r me to continue my p r o f e s s i o n a l education  23.  The audio v i s u a l d e v i c e s i n the M.I.R.C. f a c i l i tate e f f e c t i v e learning experiences  24.  M.I.R.C. p r o v i d e s materials p e r t i n ent, t o my needs  25.  Catalogue system :(indexes) was adequate t o enable me to i d e n t i f y mater i e l s pertinent to my needs  26.  M.I.R.C. e n v i r o n ment f a c i l i t a t e s concentration  27.  M.I.R.C. i s efficiently laid out  28.  Hours o f M.I.R.C. o p e r a t i o n were convenient  v l & l t to the. M . I . R . C . ple.at>e.  agree  the. appn.opn.late. n.e.6pon6e.t> :  undeecided  disagree  strongly disagree  120 strongly agree  agree  undecided  disagee. s t r o n g l y disagree  29.  M.I.R.C. was a t a convenient location  30.  Length o f M.I.R.C. v i s i t (1 week) was adequate  31.  A t present, the M.I.R.C. v i s i t s approximately  40 communities  on a one-week per l o c a t i o n b a s i s . 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 l e n g t h b u t more  frequent (3) v i s i t s  should continue t o be once per year,  but longer than one week (4) v i s i t s 32.  should be longer and more f r e q u e n t  In order t o f a c i l i t a t e p l a n n i n g o f c o n t i n u i n g education exexperiences on a long-term b a s i s , we would l i k e t o determine what.your p r e f e r e n c e s a r e . P l e a s e rank the f o l l o w i n g methods o f c o n t i n u i n g education i n order o f your p r e f e r e n c e by p l a c i n g the numeral "1" b e s i d e the method t h a t you f e e l b e s t s u i t s your needs, "2" b e s i d e the one '.: t h a t seems second b e s t and so on up t o "8". Please rank each item. RANKING (1) A h o s p i t a l l i b r a r y equipped with books, j o u r - '.. n a l s , brochures, e t c . s u i t a b l e f o r and a v a i l a b l e t o a l l members o f the h e a l t h care team.  (2) A l e a r n i n g s t a t i o n i n the h o s p i t a l equipped w i t h a tape r e c o r d e r , s l i d e p r o j e c t o r , video tape hookup and with a p p r o p r i a t e audio v i s u a l m a t e r i a l s f o r these d e v i c e s . (3) L e c t u r e s , seminars, group d i s c u s s i o n s , e t c . given or l e d by members o f the l o c a l h e a l t h care community. (4) L e c t u r e s , seminars, group d i s c u s s i o n s , e t c . g i v e n o r l e d by q u a l i f i e d people from outs i d e the l o c a l h e a l t h care community. (5) Conferences, workshops and s h o r t courses held i n larger centres. (6) A correspondence system t h a t would make a v a i l a b l e by m a i l on a s h o r t term loan tapes, s l i d e s , v i d e o tapes and f i l m s f o r use by ^..individuals o r groups. (7) A correspondence system t h a t would make a v a i l a b l e on a s h o r t term l o a n b a s i s p e r t i n e n t books, j o u r n a l s , brochures, e t c . (8) Continued v i s i t s by the P.A. Woodward Mobile I n s t r u c t i o n a l Resource Centre.  COMMENTS  T H E UNIVERSITY O F 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 P L A C E  VANCOUVER, B.C., CANADA V6T 1W5  CONTINUING EDUCATION IN THE H E A L T H SCIENCES P.A. WOODWARD INSTRUCTIONAL RESOURCES C E N T R E Phone:  Dear The P.A. Woodward Mobile I n s t r u c t i o n a l Resource Centre (M.I.R.C. was r e c e n t l y l o c a t e d i n your community. For a d e s c r i p t i o n o f t h Resource Centre, p l e a s e r e f e r to the pamphlet e n c l o s e d with t h i s letter. As p a r t o f an e v a l u a t i o n o f the e d u c a t i o n a l e f f e c t i v e n e s s o f the M.I.R.C. we would l i k e to o b t a i n i n f o r m a t i o n from h e a l t h p r o f e s s i o n a l s who d i d not use i t . We would a p p r e c i a t e your a s s i s t i n g us i n making t h i s e v a l u a t i o n by f i l l i n g out the e n c l o s e d questionnaire. W i t h i n one week o f r e c e i p t o f t h i s l e t t e r p l e a s e r e t u r n your completed q u e s t i o n n a i r e t o us i n the stamped, s e l f addressed envelope p r o v i d e d . A l l r e p l i e s are s t r i c t l y c o n f i dential . Thank you f o r your h e l p .  Yours t r u l y ,  F i e l d S u p e r v i s o r , M.I.R.C.  123  Mobile I n s t r u c t i o n a l Resource  Centre  Questionnaire f o r Non-Participants  1.  Name  2.  M a i l i n g Address  3.  Phone  4.  Had you heard about the M.I.R.C. p r i o r t o r e a d i n g the l e t t e r attached t o t h i s q u e s t i o n n a i r e ?  IF  (1) yes  (2) no  YOUR ANSWER TO QUESTION 4 WAS "NO" PLEASE GO DIRECTLY TO  QUESTION 9.  5.  How d i d you f i r s t hear about the M.I.R.C? (check one) (1) l e t t e r from the h o s p i t a l (2) telephone c a l l  from h o s p i t a l  (3) informed i n person by someone i n a u t h o r i t y at  the h o s p i t a l  (4) l e t t e r from S o c i a l Work c o n t a c t person (5) telephone c a l l  from S o c i a l Work c o n t a c t person  (6) informed i n person by S o c i a l Work c o n t a c t person (7) informed a t a meeting (8) saw i n t r o d u c t o r y t a p e - s l i d e p r e s e n t a t i o n (9) saw n o t i c e on h o s p i t a l 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 r e p o r t s  from M.I.R.C. users l e d me t o  b e l i e v e t h a t 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) 9.  Other  (specify)  Please help us t o understand your f e e l i n g s about the M.I.R.C. p r o j e c t by checking the responses t h a t best reactions  t o the f o l l o w i n g statements. strongly agree  (1) I f e e l t h a t I do n o t r e q u i r e f u r t h e r prof e s s i o n a l education (2) I p r e f e r t o l e a r n as a member o f a group (3) I p r e f e r t o l e a r n on my own (eg. reading, journals) (4) I f e e l t h a t audio v i s u a l devices do not facilitate eff e c t i v e ' learn -, ing experiences 1  (5) I would l i k e t o have made use of the M.I.R.C. t h i s week  agree  i n d i c a t e your  (Answer a l l i t e m s ) .  undecided  disagree  strongly disagree  126 10.  COMMENTS  11.  SEX:  12.  What i s your age?  13.  What i s your m a r i t a l  (1) male  (2) female  status?  (1) s i n g l e  (3) widowed, d i v o r c e d o r  (2) married 14.  a.  separated  In what country  d i d you o b t a i n your p r o f e s s i o n a l  education? b. 15.  I f Canada, i n what Province?  What i s your c u r r e n t h e a l t h p r o f e s s i o n or occupation? (1) D e n t i s t r y  (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. L i b r a r y  (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 (7) corrections (3)agpernicvyate practice (8) Other (specify) (4) public welfare  b. If you are employed by a hospital, how many beds does 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 y 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 f a m i l y (4) stop working  f o r an i n t e r v a l o f time f o r p e r s o n a l  reasons but p l a n t o r e t u r n t o f u l l or p a r t time employment  later  (5) undecided 23.  Approximately how many p r o f e s s i o n a l workshops, s h o r t courses and conferences have you attended i n the p a s t year? (number)  24.  Approximately how many books  ( i n c l u d i n g r e f e r e n c e books) have  you read i n the past year? (number) 25.  Approximately how many i s s u e s of p r o f e s s i o n a l s j o u r n a l s have you read i n the p a s t year? (number)  26.  Which o f the f o l l o w i n g a i d s to l e a r n i n g have you used i n the past year?  (check each  item)  (i)  tape r e c o r d e r :  (1) yes  (2) no  (ii)  t a p e - s l i d e programme:  (1) yes  (2) no  (iii)  v i d e o tape: ( t e l e v i s i o n film)  (1) yes  (2) no  (iv)  8 mm f i l m s or f i l m l o o p s : (home movie s i z e )  (1) yes  (2) no  (v)  16 mm f i l m s : ( f u l l l e n g t h movie s i z e )  (1) yes  (2) no  (vi)  programmed i n s t r u c t i o n :  (1) yes  (2) no  129 27.  A t present, the M.I.R.C. v i s i t s approximately  40 communities  on a one-week per l o c a t i o n b a s i s . Do you f e e l t h a t (check one) (1) one week p e r 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 l e n g t h but more  frequent (3) v i s i t s should continue t o once per year, but longer than one week (4) v i s i t s 28.  should be longer and more frequent  In order t o f a c i l i t a t e p l a n n i n g of c o n t i n u i n g education experiences on a long-term b a s i s , we would l i k e t o d e t e r mine what your p r e f e r e n c e s a r e . Please rank the f o l l o w i n g methods of c o n t i n u i n g education i n order o f your p r e f e r e n c e by p l a c i n g the numeral "1" beside the method t h a t you f e e l best s u i t s your needs, "2" beside the one t h a t seems second b e s t and so on up t o "8". Please rank each item. RANKING (1) A h o s p i t a l l i b r a r y equipped w i t h books, j o u r n a l s , brochures, e t c . s u i t a b l e f o r and a v a i l able t o a l l members of the h e a l t h care team. (2) A l e a r n i n g s t a t i o n i n the h o s p i t a l equipped w i t h a tape r e c o r d e r , s l i d e p r o j e c t o r , v i d e o tape hookup and with a p p r o p r i a t e audio v i s u a l m a t e r i a l s f o r these d e v i c e s . (3) L e c t u r e s , seminars, group d i s c u s s i o n s , e t c . g i v e n or l e d by members o f the l o c a l h e a l t h care community. (4) L e c t u r e s , seminars, group d i s c u s s i o n s , e t c . g i v e n or l e d by q u a l i f i e d people from outs i d e the l o c a l h e a l t h care community. (5) Conferences, workshops and s h o r t held i n larger centres.  courses  A correspondence system t h a t would make a v a i l a b l e by m a i l on a s h o r t term loan b a s i s tapes, s l i d e s , v i d e o tapes and f i l m s f o r use by i n d i v i d u a l s or groups. A correspondence system t h a t would make a v a i l a b l e by m a i l on a s h o r t term loan b a s i s p e r t i n e n t books, j o u r n a l s , brochures etc. Continued v i s i t s by the P.A. Woodward Mobile I n s t r u c t i o n a l Resource C e n t r e .  APPENDIX B Specifications  F o r The  Vehicle,  I t s Major M e c h a n i c a l Equipment, And  F o r The A u d i o V i s u a l  Carried  By The MIRC  Equipment  132 SPECIFICATIONS FOR THE VEHICLE AND MAJOR EQUIPMENT BUS - Model IC3741 B r i l l Bus manufactured by Canadian Car and Foundry L i m i t e d i n F o r t W i l l i a m , O n t a r i o i n 1947. i s powered by a 210 H a l l (See  It  S c o t t pancake g a s o l i n e engine.  accompanying schematic, page 32).  GENERATOR - Onan model 10.0 CCKB - # CR 10 KW,  42 120/240 v o l t ,  s i n g l e phase, 6 0 c y c l e g a s o l i n e 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 c o n d i t i o n e r . HEATER - 8 KW,  240 v o l t e l e c t r i c  heater.  FAN - Model A 1232 LECO fan w i t h 120 v o l t ,  1/6 horse power  motor. SPECIFICATIONS.FOR  AUDIO-VISUAL EQUIPMENT  VIDEOTAPE RECORDER - 1 Sony AV 3600 h a l f i n c h v i d e o c o r d e r . TELEVISION MONITORS - 2 Sony CVM  1100 M o n i t o r / R e c e i v e r s  (Black and White). TAPE RECORDERS - 3 Wpllensak 2550 A/V tape r e c o r d e r s . SLIDE PROJECTORS - 3 Kodak Model "Ektagraphic" AV-343 s l i d e p r o j e c t o r s w i t h 3" l e n s . FILM PROJECTOR - 1 F a i r c h i l d  "Seventy-31" super 8 mm  film  projector. AUTOTUTOR - 1 Sargent Welch S c i e n t i f i c Mark I I I A u t o t u t o r .  APPENDIX C  Communities Included  In The  I t i n e r a r y Of The MIRC P r o j e 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 .13to August 1.18 Enderby August 20to August 25 Golden August 27to September 1 Revelstoke September 4to September 8 Salmon Arm September 10to September 15 Lillooet October 1to October 6 Lytton October 9to October 13 Ashcroft October 15to October 20 Squamish October 29to November 3 Sechelt November 5to November 10 Powell River November 12to November 17 Break for Christmas holiday, preparation of an interim November 19to January 11 report, and repairs to vehicle and equipment January 14to January 20 Campbell River Comox January 22to January 27 Ladysmith January 29to February 3 Chemainus February 5to February 10 Ganges February 12to February 17 Alert Bay March 5to March 10  135  APPENDIX D  Schedules of Operation  136 SCHEDULES OF OPERATION SCHEDULE I ARMSTRONG AND ENDERBY  DAY OF THE WEEK  TIMES OF DAY  Monday  Noon t o 9:00 p.m.  Tuesday t o F r i d a y  9:00 a.m. t o 9:00 p.m.  Saturday  9:00 a.m. t o Noon  NUMBER OF HOURS  DISTRIBUTION OF VISITS  3  8.42%  48  84.21% 7. 37% 100.00%  54  TOTALS  SCHEDULE I I GOLDEN TO POWELL RIVER  DAY OF THE WEEK  TIMES OF DAY  Tuesday t o F r i d a y Saturday Sunday TOTALS  NUMBER OF HOURS  DISTRIBUTION OF VISITS  Noon t o 10 :00 p.m.  40  66.97%  10:00 a.m. to 10:00 p.m.  12  18.05%  3  14.98%  55  100.00%  9:00 a.m. to Noon  137 SCHEDULE I I I CAMPBELL RIVER TO ALERT BAY  DAY OF THE WEEK  TIMES OF DAY  NUMBER OF HOURS  DISTRIBUTION OF VISITS  Tuesday t o F r i d a y  Noon t o 10:00 p.m.  40  66.97%  Saturday  9:00 a.m. t o 9:00 p.m.  12  18.05%  Sunday  12:00 Noon t o 10:00 p.m.  10  14.98%  62  100.00%  TOTALS  

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