The Settings > Health Care > Q&A with Professionals > Dr. Locatis

Craig Locatis, Ph.D.

What led you to pursue an ID career in health sciences?

I did not start my career in instructional design and development looking to work specifically in the health field or in a government institution for that matter. I ended up working at the National Library of Medicine partly by design, but partly by accident. So, to understand the answer to this question and some of the others that follow, I need to provide a brief sketch of my career.

My first job in the field was after I earned my master’s degree. It was at a regional educational laboratory in the southwest where I worked on developing materials teaching pre-reading concepts and vocabulary to kindergarten children. This experience was very important to me and, ironically, affected my later career choices and professional outlook in two respects. First, the laboratory did some of the most advanced research and development work at the time and its senior staff were some of the most well known (at least three have been Presidents of the American Educational Research Association). Second, the senior staff was very good at bridging theory and practice, but they were also very practical. I believe this was because the lab was a quasi-government institution, since it was supported entirely by federal funding. Accountability and accomplishing valid educational outcomes trumped validating theory every time. By and large, the people at the lab worked very well together trying to accomplish good things. My practical experience at the lab helped keep all the discussion about instructional development and design theory that I encountered in graduate school in perspective.

I taught in academic settings after I earned my doctorate and at that time that I worked with my friend and colleague Skip Atkinson as a consultant to the National Library of Medicine (NLM). We were developing training programs on simulation design for health science faculty and, when one of the staff who operated the program left, I was approached about coming on board. I did so with some reluctance, arranging initially to work while on leave from my academic appointment rather than become a government employee right away because I thought working in the government might be too political. It did not take me long, once there, to realize that working for NLM was very much like my first job at the research lab. (NLM is one of the institutes at the National Institutes of Health and, in addition to being a library, supports and conducts research and development related to the use of information systems in healthcare.) Moreover, in my first years at the library, I developed and conducted workshops that trained health science faculty to design learning resources. There may have been a selection factor, since only those faculty most concerned about their teaching tend to attend such faculty development workshops, but I met hundreds of health science faculty in all the disciplines (medicine, veterinary medicine, dentistry, nursing, allied health) and I did not encounter a single person I did not like. This experience with the health professions has carried over to my other work, especially that involving the establishment of a demonstration center at the Library where we showcased multimedia programs in health professions education, consulted with faculty, and conducted workshops, and in my current work with health professionals in externally funded and internal research and development on the use of advanced networks in healthcare.

The healthcare professionals that I have worked with have been some of the brightest, most dedicated, and often most idealistic people that I have ever encountered, and working in a government research setting has been far less political than I ever imagined. Where I work the overall goal is to provide healthcare practitioners and consumers with the information and education that they need. Doing this may not always be sufficient to engender better health outcomes for individuals or society, but it usually is a pre-condition. Although I did not start my ID career with the aim of working in healthcare because the goals were worthy or the people are nice, I thought, perhaps, that would be the case. It was a premonition that has been borne out by experience and it has been a driving influence ever since I started working in the field.

What courses should students take and what experiences should students have to prepare?

The traditional courses in instructional design and development that have been most useful to me have been those that have sharpened my analysis skills. Courses involving assessing performance problems, analyzing intellectual skills and tasks, and evaluation have contributed most. Internship and other experience involving the application of these skills are just as important. These skills can be generalized so it is not absolutely essential that they need to be learned or applied in healthcare contexts. Still, getting internship or work experience in healthcare helps develop an appreciation and understanding of the priorities and culture (some of which I tried to highlight in the chapter).

When I refer to performance analysis, task analysis, and evaluation, I do not just mean in the formal sense of designing instruction. In the area of evaluation, for example, criterion referenced measurement and formal quantitative research methods are indeed important (most clinical trials involve randomization and control groups as do many of the projects that we fund at the Library), but qualitative methods are crucial too. Similarly, while one of the tenets of performance analysis is that not all performance problems are solved by developing instruction, one needs to look beyond custom performance support systems that are often touted as alternative solutions by ID practitioners. In the health sciences, database and information systems, electronic medical record systems, expert systems and telemedicine applications need to be added to the mix. The systematic thinking that is required to design and develop instruction is needed to develop these other alternative applications as well.

I think ID students can benefit greatly by taking courses in computer science, especially those dealing with human-computer interaction (HCI). I am not just talking about courses where students learn about web site design and administration or some graphic or programming tools. The field of human-computer interaction has a solid ergonomic and psychological research base that has much in common with ID, but much that is unique as well. It offers a different perspective for looking at performance problems, especially when technology is involved. For example, transparency is one powerful guiding concept in the design of computer systems; the idea that the user should be largely incognizant of the interface. The hammer is often presented as the gold standard designers should strive for because, when the tool is employed, the user’s mind is totally focused on the task to be accomplished and the nail that is to be hit, rather than the handle (interface) being used to accomplish the task. There is a rich body of HCI research on methods for reducing cognitive overhead in varied computer interfaces designed to accomplish different tasks that instructional designers can use in solving performance problems or incorporate into the interfaces of educational programs. HCI research on sense of presence in interactive telecommunication has implications for telemedicine, collaborative work, and distance learning. Rapid prototyping, a common technique in HCI often can be used as an alternative to more formal instructional development models.

What is most rewarding working in health care?

The most rewarding part of working in healthcare is the knowledge that you are working in a field where the aim is help others and to avoid doing harm. We need competent health professionals and well informed health consumers. We need to advance how information technology can support health science research, education, and practice. I am often removed from the front lines of healthcare working in R&D, but every once in awhile I will get a request from a friend, relative, or a friend of a friend or relative who is seeking information about a condition that is very rare. I am almost always able to point them to resources in our databases or at other health science centers (or even to a clinical trial) that addresses their problem and I am always gratified by the outcomes. Those receiving this information often have been able to identify researchers and practitioners at the cutting edge of dealing with their problems and have obtained appropriate care. They all have been better able to understand and cope with their problems.

What advice would you give to masters or doctoral students wanting to pursue instructional design careers in health settings?

My advice is to not limit yourself to instructional design, either in looking for employment options, your career interest, or your professional preparation. While there are people who do nothing but design instruction in healthcare, the number is limited compared to those involved in the total healthcare education and performance enterprise. Many medical education departments devote more time to assessment than instructional design. When instructional design methodologies are employed, it is often at a more global level to make sure the curriculum meets certain standards or to implement an overall approach, such as problem based learning, than it is to create a specific instructional program or product. Moreover, medical informatics is emerging as a field devoted to the research and development of a range of computer-based applications (including computer-based education programs) supporting healthcare. The design and development of information resources, user friendly interfaces, telemedicine, and consumer health applications are critical concerns in medical informatics and they are very crucial for advancing healthcare. Many of the skills related to analyzing performance and instruction problems and evaluation are generalizable to this broader context. Working in these other areas can be very rewarding and you should not limit yourself if you can make a contribution.

I still organize workshops and tutorials and work on educational programs, but this is not all that I do. I am a Project Officer responsible for externally funded information infrastructure projects in health that either have an education component or have outcomes with implications for education. Their main focus, however, is on telemedicine and collaboration. The same can be said for previous externally funded projects that I have been responsible for and much of our internally focused research. Telemedicine and education applications can be piggybacked or at least share the same infrastructure. My general ID, research, and evaluation skills have been useful, but mush of the work that I do is somewhat a field of traditional instructional design and development. The same can be said for much of my previous work on developing the interface for NLM’s first publicly accessible online catalog, connecting foreign medical libraries to the Internet, and other efforts related to building information infrastructure. When you work on the interface to a computer-based application, for example, you want to do everything possible to obviate the need for instruction or even performance support and, nowadays, when you working on education or information applications involving technology you need to be concerned with infrastructure (or enhancements to infrastructure) that can support them.

Are there any drawbacks to preparing for an instructional design career in the health sciences?

The answer to this question depends, in part, on how you define instructional design. Job opportunities diminish when instructional design is viewed narrowly instead of broadly (see the question above). I do not want to imply that non-health professionals have limited opportunities for advancement. Educators can be directors of medical libraries, departments of biomedical communication, and departments of medical education in academic settings. They can have ranks as high as associate deans, vice presidents, and provosts. Still, most of the very top leadership positions in health will be held by health professionals. Often health professionals with interest in or responsibilities for education will augment their skills by taking workshops or courses in ID and some seek degrees or certificates in the field.

Are there any examples of instructional design and development in health? Are any relevant to creating case studies?

There are many examples of ID in health, but most examples (including those online) are not publicly accessible. They are restricted to students enrolled in academic programs or to health professionals seeking continuing education. I have listed some publicly accessible online resources below. Some point to learning resources in other formats, such as CD-ROM or DVD. Some of the sources are to health information sites, many of which have educational materials. (As I stated in my chapter, the distinction between information resource and learning resource is not always clear cut, anyway.) Most of the resources listed illustrate many of the concepts introduced in my chapter. (I have included online resources in different health science settings and resources that illustrate consumer health information and education, continuing education, problem-based learning, evidence-based medicine and so forth.) Cases could be created from many of the resources that I have annotated below. Although the sites illustrate several of the concepts discussed in the chapter, many are useful health resources in their own right. Non-health professionals seeking reliable information about a disease or condition would benefit from the MedlinePlus site. Children seeking information related to health or parents needing to explain health issues to their children (not only diseases and conditions, but emotions and feelings) would benefit from the KidsHealth site.

Are there any examples of instruction in health care that you could refer us to for inclusion in our web site and repository?

Please click HERE for a list of Health Science Web Sites which Dr. Locatis provided.

If there is only one thing that students should remember from the health care chapter, what would it be?

People in the instructional design field are often pre-occupied with their specialty and what makes them unique. This is probably because the field is so new (compared to other professions or education specialties) that those in it feel more compelled to define themselves. But I think it is an error to over specialize and too look at oneself and one’s skills too narrowly. The problems in health care are too complex to be solved by one specialty or approach. Students need to view their skills expansively. They need to consider how varied performance solutions and technology applications can contribute to improving health care and how they can contribute to developing applications that include but go far beyond instruction.

Is there other information not on the questionnaire that would like to mention?

I would be remiss if I did not mention some of the people that I have worked with both inside and outside the field for extended times that have shaped my professional beliefs. They include Michael Ackerman, Francis (Skip) Atkinson, Phillip Doughty, Donald Ely, Dennis Gooler, Norman Higgins, Daniel Masys, Alexa McCray, Karen Medsker, Thomas Mott, Henry (Moon) Mullins, Ok-choon Park, Roger Scott, Suzanne Stensaas, Howard Sullivan, Phyllis Van Orden, and Michael Weisberg. This list does not include many others with whom I have worked or interacted for shorter time periods or the many people whose ideas I have read.