On-campus education vs. online education! Is one better than the other? Can one completely replace the other? Indeed it seems that online education is the way of the future. Educational institutions, corporations and government organizations alike already offer various forms of electronic teaching. However, can a computer truly replace a teacher and a blackboard?How people learnEach individual has a form of learning that suits them best. Some individuals achieve fantastic results in courses taught online, however most people drop out of 100% computer-led courses. Educational institutions, as well as companies in carrying out staff training, must recognize that there is no ideal way to carry out the teaching of a large group of individuals, and so must design programs that best suits the needs of the group as a whole.People learn using multiple senses. This involves learning through both theoretical components of a course, as well as social interaction with both instructors and other students. Students learn from each other’s mistakes and successes, not just from what they are told by instructors.Each individual student has an ideal learning pace. Instructors are therefore faced with the challenge of designing courses that move forward such that those students with a slower learning pace do not get left behind, while not moving so slowly that students with faster learning paces get bored.Online educationIn the age of high-speed information transfer, online education is becoming a popular and cheap means for delivering teaching to individuals outside the classroom, and in some cases all over the world. Teaching can be via CD, websites, or through real-time online facilities such as webcasts, webinars and virtual classrooms. However, different methods of online education each have their own advantages and disadvantages.Online education is still a relatively new concept, and in many respects still in the teething stages. As such, various problems arrive across different online education environments. For example:1. Lack of immediate feedback in asynchronous learning environments: While some online education environments such as webcasts, webinars and virtual classrooms operate live with the addition of an instructor, most do not. Teaching that is delivered through a CD or website, although having the advantage of being self-paced, provides no immediate feedback from a live instructor.2. More preparation required on the part of the instructor: In an online education environment, an instructor can not simply stand in front of a whiteboard and deliver a class. Lessons in online education environments must be prepared ahead of time, along with any notes and instructions that may accompany the teaching.In many cases it would also be necessary that the instructor not only understands the concepts being taught, but the technology used to deliver that teaching. This therefore increases the skill-levels needed of online education instructors, placing greater demand on educational institutions.Staffing levels may also be higher for courses run in an online education environment, requiring for example:The Instructor – able to teach both course content and be skilled in the use of technologies involvedThe Facilitator – to assist the instructor in delivering content, but may do so remotelyHelp Desk – to offer assistance to instructors, facilitators and students in the use of both software and hardware used to deliver the course.3. Not all people are comfortable with online education: Education is no longer only sought by the world’s youth. With an increased trend towards adult and continuing education, there is a need to design courses suitable for students over a larger age-range, as well as students from different and varied backgrounds. It is difficult, however, to design online education environments suitable for everyone.4. Increased potential for frustration, anxiety and confusion: In an online education environment, there are a greater number of parts making up the system that can fail. Server failures may prevent online courses from operating. Software based teaching applications may require other specific components to operate. Computer viruses may infect software necessary to run online education environments. If these systems are complex, students may choose the ease of On-campus education rather than taking the additional time and effort necessary to master the use of online education systems.5. The Digital Divide: Many people who live in remote areas and developing countries do not have access to computers, making any form of online education virtually impossible. For this reason, online education is only able to be targeted at the people lucky enough to be able to take advantage of the technology involved. Similarly, offering live teaching across the world means that different time zones and nationalities increase the demand for multi-skilled instructors.In addition to these, there are also several legal issues associated with maintaining an online education environment. For example, intellectual property laws, particularly those relating to copyright, may or may not fully cover electronically created intellectual property. For example, information on a website is not necessarily considered to be public domain, despite being available to everyone. However, the Australian Copyright Act was amended in 2001 to ensure that copyright owners of electronic materials, including online education environments, could continue to provide their works commercially.On-Campus EducationStill the most common form of instruction is traditional classroom-style learning. These instructor-led environments are more personal than online education environments, and also have the advantage of allowing for immediate feedback both to and from student and teachers alike. However, the classroom allows for less flexibility than courses run in online education environments.Instructors in modern classroom environments are still able to take advantage of several forms of electronic teaching tools while still maintaining the atmosphere associated with the traditional classroom environment. For example, PowerPoint slides can be utilized instead of a whiteboard or blackboard. Handouts can be distributed via course websites prior to the event. However, on the day, students are still able to actively participate in the lesson.Like online education environments, On-campus education comes with certain drawbacks, the most common of which is the classroom itself. This requires a group of people which, in a university for example, could reach a few hundred people in size, to gather in the same place at the same time. This requires enormous time and financial commitment on behalf of both the students and the educational institution.However, it is this sort of environment that is most familiar to students across the world. People of all ages can access a classroom environment feeling comfortable with the way that a classroom-run course is carried out. Older students who may not be comfortable with the use of information technology are not required to navigate their way through possibly complex online education environments, making On-campus education the most accessible form of teaching.On-campus education has one advantage that 100% electronically delivered courses can not offer – social interaction. Learning comes from observing, not only what is written on a page or presented in a slideshow, but what is observed in others. Most students are naturally curious, and so will want to ask questions of their instructors. The classroom environment allows students to clarify what is being taught not only with their instructors, but with other students.So, Which is Better?There is no style of instruction that will best suit every student. Studies have shown (Can online education replace On-campus education) that courses where online education is used to complement On-campus education have proved more effective than courses delivered entirely using only one method. These courses take advantage of both online education materials and a live instructor, and have produced results higher than those of students in either 100% online education or classroom environment courses. Students have the advantage of the immediate feedback and social interaction that comes with the classroom environment, as well as the convenience of self-paced online education modules that can be undertaken when it best suits the student.It would seem that online education environments will never completely replace On-campus education. There is no “one size fits all” method of teaching. Teaching styles will continue to adapt to find the method that best fits the learning group. Using a mix of online education environments and classroom sessions, educational institutions, corporations and government organizations can ensure that training is delivered that is convenient and effective for both instructors and students alike.
KERRY’S STORYKerry was a 42-year old female executive who was in excellent health. She was married but had no children and had never been pregnant. She was a non-smoker with no past medical history and no family history of cancer. Specifically, Kerry had no history of sexually transmitted diseases and she was HIV negative. When she noticed blood on the toilet paper after her bowel movements, she first thought that the problem was due to hemorrhoids. However, after two weeks, the bleeding increased and was accompanied by pain and itching around the anus. She went to her primary doctor whose exam revealed a 2 x 2 inch mass at the anal sphincter. Her doctor did not feel any abnormal lymph nodes in her groin. He referred her to a colorectal surgeon who performed a colonoscopy. That examination confirmed the mass seen by her primary doctor but no other lesions. Biopsy revealed a squamous cell carcinoma, anal cancer.After her diagnosis, Kerry’s surgeon sent her for a PET/CT scan which revealed abnormality only at the anal mass. There was no distant activity to suggest metastatic (distant, incurable) spread of her cancer. Her surgeon referred her to a radiation oncologist and medical oncologist. They recommended radiation therapy (RT) and chemotherapy delivered together (concurrent chemoRT) which she underwent over a period of 6 weeks. Kerry was treated with intensity modulated radiation therapy (IMRT) in order to minimize RT dose to critical organs including the small bowel and bladder, while treating potential microscopic cancer cells within the lymph nodes in her pelvis and groin and the anal tumor. She received concurrent mitomycin and fluorouracial chemotherapy by IV infusion as an outpatient. Kerry had expected side effects of treatment including severe irritation and redness of the skin in the groin and anus, but she did not require a break during IMRT. She had significant fatigue that kept her out of work during most of her chemoRT. She had some loose bowels which were well controlled after adjusting her diet. Near completion of her treatment, there was no evidence of any tumor remaining. She recovered from the side effects of treatment over about six weeks. Kerry has seen one of her cancer doctors every three to six months for the past five years and she remains cancer free!BASICSAlthough it’s one of the least common cancers of the GI tract, there are still about 5000 cases of anal cancer diagnosed in the U.S. each year. There are more women than men diagnosed. The average age at diagnosis is around 60 years old, but it can occur in patients in their 30s and 40s. If the disease is localized, which is the case for 50% of patients, then the cure rate is roughly 80%.RISKS & CAUSESThe majority of patients who are diagnosed with anal cancer don’t have a clearly defined risk factor. However, factors that increase the risk of developing anal cancer are associated with the risk of human papillomavirus (HPV) infection. This virus is the same kind that causes genital warts. Certain strains of the HPV virus are associated with a high risk of developing anal cancer as well as cervical cancer and some types of throat cancer. Activities that put people at risk for HPV, like receptive anal intercourse, also put them at risk of later developing anal cancer.SIGNS & SYMPTOMSPatients often present to their doctors with complaints of anal pain or bleeding. Many patients ignore or downplay the symptoms, often initially attributing them to hemorrhoids. While most people who have these symptoms don’t have anal cancer, persistent pain or bleeding should always prompt medical attention. Less commonly, patients will complain of itching or a painless mass in the groin. A lump can develop in the groin as a result of anal cancer spreading to lymph nodes and causing them to enlarge.DIAGNOSISThe diagnosis of anal cancer is usually made by biopsy of the anal mass or area of ulceration. Generally, this procedure is performed by a medical GI specialist or surgeon. These doctors are able to directly look into the anal canal and rectum by proctoscopy (or the entire colon by colonoscopy) with special instruments after they deliver medications to minimize discomfort. Biopsies are performed during these procedures, after sedation and/or injection of numbing medicine. Most anal cancers (80%) are squamous cell carcinomas. A thorough evaluation of someone suspected of having anal cancer should also include examination of the pelvis, particularly both groins. If lymph nodes are enlarged, then they may also be biopsied. Many enlarged lymph nodes are only inflamed, with no evidence of cancer. Blood tests that may be ordered include complete blood count, tests of kidney function, and possibly HIV testing, depending on the patients’ risk factors for the virus.STAGINGThe American Joint Committee on Cancer (AJCC) TNM staging system is used to determine if anal cancer is localized (early stage) or has spread to other sites (advanced or late stage). Early stage disease is limited to the anus, while advanced disease refers to cancers that have invaded nearby organs or lymph nodes in the pelvis or groins. Imaging studies should include CT scan of the abdomen and pelvis and a chest X-ray at minimum. Staging may also include a PET/CT scan. This imaging test allows the radiologist as well as the treating cancer specialists to see if the anal cancer has spread to involve lymph nodes in the groin or pelvis, or metastasized to other sites in the body such as the liver or lungs.TREATMENTThe standard treatment for anal cancer doesn’t involve surgery, which comes as both a surprise and a relief to many patients. Since most anal cancers invade the sphincter that controls defecation, surgery to remove such a cancer would require removal of the sphincter and creation of a colostomy. Therefore, surgery is generally avoided in favor of treatment that will keep the anal sphincter intact. An exception would be very early cancers of the anal margin, on the skin outside the anus.Concurrent chemoRT is the standard treatment for the majority of patients with anal cancer, to obtain the best chance of cure with sphincter preservation. RT delivered over roughly 6 weeks with concurrent IV fluorouracil (5FU) and mitomycin-C (MMC) chemotherapy provides patients the best chance for cure. RT is delivered in daily fractions using either 3D conformal RT or IMRT. The latter technique may be used in order to minimize the amount of normal bowel and/or genitalia receiving full-dose RT (& therefore minimize side effects).The main side effects that are possible during RT to the anus and pelvis include skin reaction that may be severe around the anus and creases of skin at the groins, as well as bowel irritation and diarrhea. Most patients will have these acute symptoms resolve within 1-2 months following completion of treatment. Extremely rare (<1%) but serious side effects include bowel obstruction or fistula (a hole between the anus and bladder or urethra). 5FU may also cause bowel irritation, diarrhea, irritation in the mouth or lips, poor appetite, and fatigue. Uncommonly, skin or nail discoloration or severe peeling of the hands and feet (hand foot syndrome) or other major side effects can happen. In rare cases, heart problems including heart attack can occur. MMC may cause decrease in blood counts, mouth sores, poor appetite, and fatigue. Nausea, vomiting, and urinary irritation may also occur. Rarely, life-threatening lung or kidney damage can occur.