Will ‘free’ and ‘open’ rule the day as the future of online education?

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Different seas, same boats? Column

by Dr. Peter Murray, Senior Editor


Murray, P. (2012). Will ‘free’ and ‘open’ rule the day as the future of online education? Online Journal of Nursing Informatics (OJNI), 16 (3), Available at  http://ojni.org/issues/?p=2009


Those who are familiar with my background and interests will be aware that I have long been an advocate of free/libre and open source software (and related application of the philosophical underpinnings to other areas of endeavour) (e.g., Murray, 2008, 2010; Murray & Erdley, 2011). I have also supported the development of open access models for the publication and sharing of scientific information. How does this relate to the provision of educational opportunities, though? If something is truly ‘free’, as in there being no financial cost to access it, and it being available for anyone to access and use, can it have intrinsic value or be of high quality, and will it be valued and used by people to further their knowledge?

The arguments in favour of the benefits of free/libre and open source software (FLOSS) seem largely to be well-demonstrated, even if there is still resistance in many organisations, especially healthcare organisations, to its widespread use. The Internet relies for its functionality on open and non-proprietary standards, and many people routinely use FLOSS products, albeit often without realising this, probably knowing, or caring, little about the history. The web browser market is now dominated by open source products (Chrome and Firefox account for more than 50% market share; W3Counter, 2012), while the open source Android operating system accounts for the majority of current smartphone sales globally (Reed, 2012). However, one has to admit, the use of open source desktop tools and operating systems lags far behind these, for a range of reasons that it is not the purpose of this particular column to explore. Open access models for publishing, whereby scholarly journals and articles are available with unrestricted online access, continue to grow, in part driven by the increasing expectations and requirements of funding bodies in many countries that research what they support is made available through this mechanism. There is emerging evidence that open access journals have citation levels and impact factors approaching, or even exceeding, those of journals published by traditional subscription models (Bjork & Solomon, 2012; Eysenbach, 2011). In the education realm, one of the early FLOSS-like developments was the MIT OpenCourseWare (MIT OCW), an initiative of the Massachusetts Institute of Technology (MIT) that began as a pilot in 2002, aiming to put all of the educational materials from MIT’s undergraduate- and graduate-level courses online, openly available to anyone, anywhere. Other educational institutions, for example The Open University in the UK, are also making some of their materials freely available, although no educational institutions seem yet to have gone as far as MIT.

However, most open courseware initiatives arise from the activities, collaborative or individual, of well-funded educational institutions, that are known for the quality of their production processes and values. Is it possible for the more ‘home grown’ philosophy that underpinned much of the early development of FLOSS to apply in the development of good quality educational materials? If it is, then might there be scope for the collaborative development of materials and courses to support the educational needs of nurses around the world. In the same way that scientists, health care professionals, and institutions in lower and middle income countries (LMIC) often do not have the resources necessary to access scholarly literature, but have the greatest need, and so open access models of publishing provide great benefit – might access to open courseware or similar provision of educational materials help to meet the needs for education of nurses and other health professionals?

I want to introduce two recent developments that provide possible examples of ways in which educational materials might be developed in the future. The first is the “The Social MEDia Course” (http://thecourse.webicina.com ), an online collection of presentations and tests, freely available to anyone to undertake and deal with the ways in which social media are, and might be, used by medical students and health professionals. I have to declare an interest here, as I am a member of the Advisory Board for the course, which aims to ensure constant improvement and explore directions for future developments; however, I will try to provide relatively objective comments. The course has been developed by Dr. Bertalan (Berci) Mesko, a young medical doctor from Hungary, who has become something of a trailblazer in exploring the ways in which social media might be used in many areas of health and education. The course started with face-to-face delivery to medical students at several universities in Hungary, but due to feedback from colleagues, Berci has recently done a reversion of it for online, self-paced delivery and self-assessment through quizzes linked to each presentation. The materials are continuously updated as a result of feedback and new developments, but development and delivery relies on volunteer effort, rather than institutional or other sources of funding. The Social MEDia course is, therefore, a response to an identified need, or gap in provision, and is offered in an engaging manner (as is all the best and most effective education). One can see ways in which it might be expanded, or the model offered to cover other areas of educational content within healthcare.

The second example is the “Health Informatics Forum Massive Open Online Course (MOOC)”, developed by Dr. Chris Paton (http://www.healthinformaticsforum.com/MOOC ). MOOCs are another recent development, but share many commonalities with the open courseware model described earlier, and could be seen as simply one possible, even natural, evolution of the developmental direction of online education, given the possibilities offered by the web and by Web 2.0 tools and methods. A MOOC is a “massive open online course”, a category of online course where the participants are distributed, and course materials also are dispersed, across the web. MOOCs are open and one of their main features has been the level of connection and collaboration by participants online (Masters, 2011; Wikipedia, 2012). MOOCs are based on principles arising from connectivist pedagogy. They aggregate, or provide portals to large amounts of content that may be produced at or available through different places online (and so potentially by a wide variety of people and organisations collaborating). They often provide mash-ups of content, with materials created within the course mixed with materials elsewhere, and re-purpose the materials to suit the goals of different course participants, and with the rest of the world. The potential of MOOC-like developments has been recognised commercially through development such as Udacity (http://www.udacity.com/ ), which offers a range of mainly science and computing-related courses for free based in materials developed by leading academic in the field, and Coursera (http://www.coursera.org ), a collaboration of leading, mainly North American, universities that offer courses for free based on a MOOC model of materials aggregation.

The Health Informatics Forum MOOC is based on course materials that have been developed by Columbia University, Duke University, Johns Hopkins University, Oregon Health and Science University and the University of Alabama at Birmingham through a $10 million grant from the US Office of the National Coordinator for Health Information technology (ONC), and  released under a Creative Commons License, which allows their re-use in this and other ways. It is in its early stages of development, but one can see that the course, currently very US-focused in its content, could be expanded to bring in material from other sources, or reversion the materials to meet needs in different countries.

So, what does all this have to do with nursing, and nursing informatics, meeting educational needs and sharing experiences globally, in particular with colleagues in parts of the world where the need for education may be greatest, but the opportunities to access high quality learning may be most challenging? “Seemples”, as Aleksander Orlov would say (http://www.youtube.com/watch?v=JtXb6LWlDsU). Rather than me telling you, why don’t you think about it, and let’s open some discussion in some online space to explore the potential, and interest, in using such tools and approaches to share our knowledge and experience, and perhaps collaborate among, rather than compete between, the plethora of organisations that have legitimate interests in these areas.




Björk, B-C. & Solomon, D. (2012). Open access versus subscription journals: A comparison of scientific impact. BMC Medicine, 10(73). Retrieved from http://www.biomedcentral.com/1741-7015/10/73

Eysenbach, G. (2011, June 30). Impact factors of medical informatics journals 2011 (blog post).  Retrieved from http://gunther-eysenbach.blogspot.co.uk/2011/06/impact-factors-of-medical-informatics.html

Murray, P. J. (2008). Open source and open access in healthcare – towards bridging the digital divide. Presentation at InfoLAC2008 conference, Pilar, Argentina.

Murray, P. J. (2010). Open interoperable standards in connected health, nursing and informatics. Keynote presentation at Open Health 2010 Conference and Summit, Belfast, Northern Ireland.

Murray, P. J . & Erdley, W. S. (2011). Open source and free software. In V. K. Saba & K. A. McCormick (Eds). Essentials of nursing informatics (5th ed., pp. 133-156). New York, NY: McGraw-Hill Medical.

Masters, K. (2011). A brief guide to understanding MOOCs. The Internet Journal of Medical Education, 1(2).. Retrieved from http://www.ispub.com/journal/the-internet-journal-of-medical-education/volume-1-number-2/a-brief-guide-to-understanding-moocs.html

Reed, B. (2012, August 08). Android surges in Q2, accounts for more than two-thirds of all smartphones shipped. Boy Genius Report, August 8, 2012. Retrieved from  http://www.bgr.com/2012/08/08/q2-2012-smartphone-market-share-idc/

W3Counter. (2012, August 2012). Web browser market share: August 2012.  Retrieved from http://www.w3counter.com/globalstats.php?year=2012&month=8

Wikipedia. (2012, September 07). Massive online open course. Available at    http://en.wikipedia.org/wiki/Massive_open_online_course



Proofed by Barbara Smith.


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