Scenario-Based E-Learning Model: A CDC Case Study
By Nancy Gathany and Jeanette Stehr-Green

Using a framework proposed by Clark Aldrich, the Centers for Disease Control and Prevention reflects on its recently released linear e-learning program—and the components that give it a dash of simulation. CDC concludes that the program has an engaging interface and the feel of a simulation because it's scenario-based. More important, it requires the learner to apply knowledge and skills in a realistic format.

Whether it’s a Web-delivered tutorial, a simulation of a virtual world via CD-ROM, or a simple interactive lesson downloaded from the Web, research shows that well-designed e-learning is effective. One form of e-learning that piques learners’ as well as developers’ interest is educational simulations. Simulations range in complexity from a straightforward reproduction of a software program to more intricate representations of complex environments such as an interactive community of workers. Educational simulations are designed to give learners an opportunity to practice their knowledge and skills in a risk-free environment. However, not all training needs can be met by simulations, and building simulations can be challenging for novice developers.

As a result, the developers at CDC applied a model that blends characteristics of a simulation with linear e-learning programs. A key ingredient of the model is a real-world scenario to engage learners. CDC found that developing e-learning programs based on this model required fewer resources than a typical simulation, yet the programs still seemed to make the learner feel as though they were working through a simulation. CDC refers to this model as the scenario-based e-learning model (SEM).

Background

The CDC is well known for its expertise in conducting outbreak investigations. But it’s actually the public health practitioners at state and local health departments as well as in hospitals, laboratories, and other medical settings that typically are responsible for recognizing outbreaks, initiating investigations, and performing the associated tasks of collecting, analyzing, and interpreting data. A CDC training and development team was given the task of producing an instructor-independent e-learning tool for this large audience of public health practitioners. CDC wanted to design a program that would enable learners to build on their basic knowledge of outbreak investigation as they applied information to a specific outbreak scenario. Because the audience had limited access to computers with the necessary Internet connectivity, CDC chose to pursue two delivery methods: CD-ROM and hard-drive-delivered files available for downloading from the Web.

Initially, CDC considered designing a simulation that immersed learners into an environment that charged them with the responsibilities of conducting an outbreak investigation. After reviewing the content and target audience, however, developers concluded that a full-scale simulation wasn’t the best route to take for the following reasons:

• The desired training objectives asked the learner to focus on a specific process. This meant that the learning approach needed to clearly demonstrate each step--without giving the learner too many options to deviate from an established course of action.
• The primary target audience included beginning public health practitioners with limited experience in outbreak investigations. These learners would need more didactic training than developers could easily incorporate into a simulation. More important, CDC was concerned that a full-scale simulation might overwhelm and frustrate new learners, which would result in limited learning outcomes.
• Building an effective simulation is costly and requires a team of committed developers. The resources to create this learning tool seemed less than adequate for a full-scale simulation.

So, if not a simulation, what could CDC build? In the past, CDC had success teaching staff by using a classroom case study method. With this approach, an instructor guides a group of learners through a specific scenario using print-based materials in which information about an outbreak is slowly revealed in a linear fashion. Intermittently, open-ended questions are posed to the group, and the instructor facilitates discussion. These case studies, which adequately help learners apply knowledge and practice skills, have been well received by participants.

With that in mind, CDC developers set out to design a linear, computer-based case study that would build on the success of the classroom model, without involving a live instructor. The ultimate goal was to lay the foundation for a model that would facilitate the design, development, and implementation of future self-instructional case studies, while avoid being a boring page-turner program.

Linear beginnings

The development process began by identifying a real-life outbreak investigation that would serve as a solid traditional classroom example. Developing and testing the classroom version helped clarify the structure for the e-learning version, including placement of questions and identification of topics for which learners might need remedial explanations or desire further exploration.

The simulation, however, was designed to enable each learner to work through the case study at his or her own pace without the help of an instructor. By necessity, the outbreak scenario used in the online simulation was more detailed than that provided in the classroom case study--building in characters, places, and specific timelines. As with the classroom version, questions were posed that challenged learners to apply the content and make inferences based on the information that was given to them. Question formats included multiple-choice (single- and multiple-answer), yes/no, fill-in-the-blank, and drag-and-drop activities.

Rather than relying on an instructor to give advice or guide participants, learners could access a variety of support tools, such as hints and reference materials before they answered questions. Learners that needed remedial knowledge could review didactic lessons about basic concepts. Curious learners could explore topics of interest in greater detail through vignettes presented by professionals that investigate outbreaks frequently, including an epidemiologist, laboratorian, or sanitarian. Basically, all learners could decide for themselves which supplemental learning activities to undertake.

Contrasting sharply with the classroom case studies that consist only of black text on white paper, the interface for the e-learning was an online depiction of a day-planner notebook placed on a wooden desktop. The notebook included dividers that represent the steps in a routine outbreak investigation. The background information and questions were presented as pages of the notebook. To support the notebook metaphor, other interface elements, which aren't included in classroom case studies, were placed on the desktop or clipped to the notebook, including

• snapshots that depict investigation team activities
• an epidemic curve that graphically illustrates the outbreak and investigation, which also changes as the scenario progresses
• an investigation outline that corresponds to the six steps of the outbreak investigation and contains a record of the learner’s progress
• related items such as press releases and questionnaires.

Adding simulation style

Given that the scenario was rich with opportunities for embellishment, developers had to remind themselves of an early decision to not make the program a full-scale simulation. Feedback from reviewers and learners, though, suggests that the scenario-based e-learning has simulation characteristics. Initially, CDC developers attributed that perception to the fact that a real-life scenario was presented in a story-telling manner: page-by-page, step-by-step, with intriguing details presented through text and snapshots. Just as a child is drawn in by a good story teller, CDC believes that the public health practitioner involved in such investigations couldn’t help but be captivated. But this explanation by the developers is based on cursory examination.

To explore more systematically why the linear e-learning approach had the feel of a simulation, CDC examined the program against a framework proposed by Clark Aldrich in Learning Circuits’s Field Guide to Educational Simulation. The framework, developed to help designers and customers decide what a simulation will and will not do and how it will do it, consists of the following components:

• how learners express themselves through input
• simulation calculations and branches based on learner input
• results and feedback as output that’s communicated to learners.

For each component of the framework, CDC developers identify characteristics within its scenario-based e-learning program.

Here's how learners of the CDC course express themselves through input:

• The questions posed to the learner mirror those one would wrestle with in an actual investigation. Learner input isn’t merely a recitation of facts; it’s an application of knowledge or skills, synthesis of known information, and decisions made by the learner. This makes the learner feel that his or her response to the questions play into the action of the story and have an effect on the end result.
• The interface includes tools used when investigating a real-life outbreak. The notebook is often used to record incoming facts during an investigation, an epidemic curve is a recognized method to track the progress of an outbreak, and the references include key resources that the learner will refer to frequently. Data from the original investigation is available for analysis. Using such realistic tools, the learner feels at times as though they have the ability to directly manipulate input.

Simulation calculations and branches based on input from learners revealed that even though the core of the program is linear, learners perceive that they're in control because they select available options such as remedial lessons, advanced explorations, data analysis activities, and references.

Results and feedback as output that’s communicated to learners include the following:

• Learners receive customized feedback as they answer questions and receive progress reports. This makes the program seem more spontaneous and personalized.
• The engaging visual interface draws the learner into the story through the snapshots from the field and items clipped to the notebook, such as maps, lists, and questionnaires, which add a touch of realism that let’s learners imagine that this is their own investigator’s journal.

When analyzing SEM in terms of how it correlates to Aldrich’s simulation framework, the resemblance is strongest for the input and output components. With SEM, learners are immersed in the problem and feel as if they’re participating in an investigation first hand. The model, however, is most limited with respect to Aldrich’s calculation component. Although output can vary based on learner input, the learner has no control over the basic flow of the scenario. The developers at CDC think that learner control is a key feature of a simulation. Therefore, the developers don’t feel that SEM justifies the label of simulation, but they do see why learners perceive this linear e-learning model as a simulation and how we can improve the model by building on these same characteristics.

Bottom line

Extensive formative evaluation activities, including one-on-one observations, field testing, and expert review, suggest that SEM is effective in teaching practical skills in outbreak investigation and that learners enjoyed the training experience. Early marketing data indicate that SEMs are attractive to a wide variety of public health practitioners from many geographic locations. In addition, the CDC’s first SEM program received the honor of being a vanguard product for ASTD’s eCC program and has received the Outstanding Practice Award from the Design and Development Division of Association of Educational Communications and Technology. These outcomes plus the lower cost of developing programs based on the scenario-based e-learning model—as compared with a full-blown simulation—lead the developers to conclude that CDC met its training goals.

But will future SEM efforts be successful or was the novelty of the approach a key factor to its initial success? Will it continue to engage the learner’s interest and attention as the next generation of learners, who have grown up playing computer games and surfing the Internet, enter the job market? Should the model evolve to include more characteristics of simulations? Will the model be adaptable for content other than outbreak investigation and audiences beyond public health practitioners and prove to be a standard bearer for e-learning? Only time and the learner’s curiosity will tell.