Brief Communications
Feasibility of online psychophysical practice for a department of Certified Orthoptics.
2022 年 21 巻 2 号 p. 112-122
詳細
2022 年 21 巻 2 号 p. 112-122
To evaluate the feasibility of an online practice web application and groupware platforms for medical related fields, a small web application for psychophysical experiments was developed using Hypertext Markup Language version 5 features. The application was then used in a certified orthoptics class on the Microsoft Teams 365 meeting platform for two years. The two classes in each year were divided into small groups of either twelve or six students, which were then given areal matching tasks. The students were instructed to adjust the size of the comparison stimuli by moving a web application slider to make the area equal to the standard stimuli, after which they plotted the data on a Google Spreadsheet. After each practice, questionnaires were completed by the students using Google Forms. Over the two years, 85 students completed the questionnaires. While the students managed to achieve the practice goals, they negatively scored the user friendliness of the spreadsheet, especially when there were smaller group sizes. These results suggested that it was not the web application itself but the communication tools employed in the online practice and the group sizes that had affected the student experiences.
The current COVID-19 pandemic has highlighted the importance and usefulness of online education [1–5], especially as developments in information and communication technology (ICT) now allow students to attend lessons from anywhere and engage in group activities [6]. Even medical and medical related practice, which has traditionally been face-to-face, has been moving online [7, 8]. If some orthoptic education can be delivered online, it would be safer and more convenient for many students learning orthoptics.
The possibility of delivering web based online practice sessions was explored for the certified orthoptics (CO) related department in one of the Japanese universities having a CO-related course. In a previous report [9], a Hodgkin–Huxley membrane online practice model simulator was tested, which had been written in JavaScript and had used several Hypertext Markup Language version 5 (HTML5) features. However, the simulator practice was not suitably interactive for the students, who at the time had lacked a deep understanding of sodium spike characteristics, such as the refractory period and the ionic equivalent potentials. It was also found that learning about the membrane potentials was not attractive for the orthoptics students because it was not seen to have a direct connection to human visual functions. To address this issue, a simple web based measurement application (web application) was developed focused on visual areal comparison tasks that required more user involvement. The application and group platforms were then used to test the applicability for online practice sessions.
Subjects
This study was approved by The Research Ethics Committee of Niigata University of Health and Welfare (Number: 18173-190527). The data were obtained from second-year undergraduate students who were enrolled in the “Visual Physiology Practice” course in the 2020 and 2021 school years, which is a practice course focused on basic human visual functions, such as visual acuity, in the CO-related department in one of the Japanese universities having a CO-related course. The course was run once a week over fifteen weeks in the 2020 and 2021 school years; from September 25, 2020, to January 22, 2021, and from April 9, 2021, to July 16, 2021. The web application online practice sessions, each of which was 3 hours, the same as the conventional face-to-face practice, were held once in each course in each year; one on November 13, 2020 (Day 1), and the second on April 16, 2021 (Day 2). In response to requests from some Day 2 students, a supplementary practice was also added on April 19, 2021. After each online practice session, all students were asked to complete questionnaire (Figure 1) using Google Forms. Eighty-five (44 for Day 1 and 41 for Day 2; female = 64, male = 21) out of 92 students voluntarily returned complete answers and gave informed consent for their participation. The mean student ages at the practice points were 19.7 for Day 1 and 19.1 for Day 2. All statistical analyses were performed using GNU R (https://www.r-project.org).
Online practice schedule
Microsoft Teams 365 (MS-Teams), an online conference platform, was used for the online practice sessions because it is the university's online lecture standard and the students were already familiar with its processes. At the beginning of each online practice session, the students logged on to the “General Channel” (“channel” is the term used for the individual meeting rooms in MS-Teams,) and were given a brief lecture on the principles of the point of subjective equality (PSE), the adjustment methods, and instructions on using the web application and Google Spreadsheets for the data analysis. After the students completed a common task (condition A in the “Tasks” below), they were divided into several small groups; three groups on Day 1 and six groups on Day 2. The students then left the “General Channel” to enter their assigned “small group” channels. Three teachers were monitoring these “channels” to provide support. In the way similar to the students, all the teachers logged in the “General Channel” at first, then moved to the “small group” channel(s) under their charge. Each teacher was in charge of one (Day 1) or two (Day 2) “small group” channel(s).
Web application preparation for the psychophysical test
The web application was developed using canvas and range input elements and was written in HTML5 with JavaScript (209 lines) on Macintosh computers (Mac mini, 2012 and 2014 model). Preliminary in-house tests were conducted using the Safari browser on the same computers and using 6th and 7th generation iPads. Because most students were accessing the application from outside the university's security system, a free web server (Ninja Homepage, https://www.ninja.co.jp/hp/) was used to host the web application. Before the practice, the web application URL and a tutorial PDF were sent to the students, which allowed them to easily run the application.
Psychophysical experiments on visual functions require well calibrated (luminance, contrast, gamma, etc.) stimulation apparatuses, which are difficult to prepare for online practice when students are using their own devices. To resolve this issue, rather than using a comparison of color or luminance, areal comparisons (Figure 2) were employed. A standard stimulus, such as a square or triangle (Figure 2) was alternately displayed on the right or left side (right side in Figure 2), and the comparison stimuli displayed on the opposite side. The students were required to adjust the diameter of the comparison stimulus (the circle in Figure 2) by moving the slider (a in Figure 2) until the comparison stimulus area equaled the standard stimulus. When the student pressed “Ok” button (b in Figure 2), the time and various parameters, such as the sizes of the standard and comparison stimuli, were stored within the application, after which the next trial started. By pressing the “Copy” button (c in Figure 2), the stored data were exported to the clipboard, so that the text area could be easily pasted on the spreadsheet.
Tasks
At first, all students worked on the trials under common initial conditions (condition A, the parameters are shown in Figure 2). Then, they were divided into small groups, each of which was assigned to one of three additional conditions that had modified standard stimuli: triangle (condition B); tilted (condition C); and brighter or darker (condition D). To achieve these conditions, students had to appropriately change the web application parameters (pressing button d in Figure 2). When the iterations for each condition (10 times) were reached, the students copied and pasted the results onto a specific Google Spreadsheet (Figure 3) on Day 1, and a specific Google Spreadsheet file in the group directory on Day 2. The goal of the practice was for each student to plot their PSEs against the standard stimuli area under two conditions (condition A and one other from conditions B–D).
At the end of the three-hour practice, most students had completed their PSE plots (Figure 4); however, several students took six hours. As in a previous study [10], the PSEs increased proportionally to the area of the standard stimuli, with the slope being steeper for the triangle standard stimuli condition than for the square standard stimuli. These results indicated that the areal comparison adjustment method had been successfully implemented in the online web application and groupware platform practice sessions.
The student questionnaire evaluation results on the practice environment are shown in Figure 5. The most used devices were Windows PCs (PC) and tablet PCs (Tablet) (Figure 5A), and the most used HTTP client (web browser) was Google Chrome (Figure 5B). Even though ten students were still using Microsoft Internet Explorer rather than the newer Microsoft Edge, there were no HTML or JavaScript environment incompatibility issues. All students except for one cellular line user logged in using wired or wireless local area networks (LAN) (Figure 5C). As precise control of the slider element was crucial for the adjustment method, students were asked to identify the specific pointing devices they used in the online practice sessions. Surprisingly, approximately 25% of students had operated the slide element with their fingertips instead of more precise pointing devices such as a stylus (Figure 5D), and two had even used their smartphones (Figure 5, rightmost black bar D). Despite the advertisements that kept appearing, the students highly (the medians were within the topmost two ranks out of six) evaluated the stability and user friendliness of the web application. (Figure 5E–J). However, the evaluation of the spreadsheet user friendliness, which students had to edit through the web browser (Figure 5K), was moderate (Figure 5L). The score distributions for user friendliness did not depend on the use of the pointing devices (p = 0.712, 0.652, respectively, Fisher's Exact Test for Count Data), while the medians were more favorable by one step for the both questions in the pointing device users.
The collaboration and general impression answers are shown in Figure 6. All students at least partially analyzed their data (Figure 6A). Around 48.2% gave positive (scored 4 to 6 out of 1 to 6) responses to “Discussed in the small group?” and 51.8% gave positive responses to “Consulted with teachers?” (Figure 6B and C); however, no significant correlation was found between these responses (p = 0.734, Wilcoxon rank sum test with continuity correction). Around 54.1% gave positive responses to “I understand the adjustment method” and 68.2% gave positive responses to “Psychophysics is interesting” (Figure 6D and E); however, no significant correlation was found between these responses (p = 0.126, Wilcoxon rank sum test with continuity correction). All free comments for the “Difficulties in spreadsheet operation” category were negative from Day 2 students (Figure 7A). There were significant differences between the student evaluation distributions for spreadsheet user friendliness (p = 0.0466, Fisher's Exact Test for Count Data, Figure 7B), but there were no significant Day 1 and Day 2 differences for “Data analyses by yourself?,” “Difficulties in spreadsheet operation,” “Consulted with teachers?,” “I understand the adjustment method,” or “Psychophysics is interesting” (p = 1.000, 0.177, 0.0517, 0.144, and 0.415, respectively, Fisher's Exact Test for Count Data, data not shown).
The feasibility of conducting online orthoptics field practice sessions was evaluated in two sessions over two years. Compared to the intricate online optometry education tools Acosta et al. introduced [8], the web application was smaller (currently 209 lines; skilled JavaScript programmers could rewrite this more concisely) and could run on many environments; however, users need to be able to move the slider and set the appropriate parameters (Figure 1 conditions A–D), which were features that met the proposals outlined in Cook and Dupras [11].
Consistent with a previous report [9], students were able to easily manipulate the web application using only finger control (Figure 5). However, the spreadsheet required for the data analysis presented some problems, with around 25% of Day 2 students negatively commenting. Although the MS-Teams application has been favored as an educational platform in some recent reports [12, 13], it was not found to work well in this case. When the students moved into their assigned “channels,” the members (including teachers) were unable to communicate with the members in another “channel” and could not broadcast any messages to the whole class. Therefore, a secondary communication tool, such as the instant message tool LINE, could be included as a workaround to enhance whole class collaboration and understanding.
The student evaluations also highlighted the importance of group size. To generate deeper group discussions, the group sizes were reduced from twelve for the Day 1 session to six for the Day 2 session. However, even though the communicative attitudes remained unchanged, the change in group size resulted in lower evaluations from the Day 2 students (Figure 7). Another change that possibly affected the evaluation was the spreadsheet composition. The Day 1 session used a single spreadsheet file with sheets for all group members; however, to avoid students editing the wrong sheet in the same file, each Day 2 student was given a discrete file, which possibly discouraged any student group spreadsheet collaboration. If the group had been large enough, students could have shared a common spreadsheet, which would have improved the data analysis because, in addition to the teachers, at least one student would have been familiar with the spreadsheets and could have assisted their fellow group members, that is, the individual student work would have become group work. The volunteer students had had few chances to collaborate with their classmates because of the COVID-19 pandemic, which may have been an obstacle to effective collaboration [14]. As Sarmiento claimed after observing online virtual math teams [15], the creation of joint problem spaces through repeated group work requires careful feedback from facilitators to fully harness the benefits of ICT. The results presented here may be valuable as one of the case reports of an online practice trial in a CO-related department, under current COVID-19 pandemic for a possible summary in future.
There are no conflicts of interest to declare.
