Moving on From Clark’s “Mere Vehicles” Debate Free

Forty years ago, Richard Clark (1983) professed that it is the instructional method that determines learning outcomes, while the choice of media “does not influence student achievement any more than a truck that delivers our groceries causes changes in our nutrition’ (p. 445). The most notable individual to debate this statement was Kozma (1994) to which he stated that media does impact student outcomes due to a combination of the media and instructional methods used in delivery of content to the learner. More recently, Hastings and Tracey (2005) challenged the debate in itself by stating “The question is no longer if; the question is how” (p. 2). Therefore, the purpose of this paper is to review the various positions on media, instruction, and impact on learning outcomes. In addition, how this information relates to the current state of technology and physical therapy education will be discussed.

The primary target audience for this white paper are physical therapy practitioners and educators. However, as interprofessional collaborative education and practice continues to evolve, other health care professionals are targeted. Health care educational accreditation organizations have required integration of interprofessional collaborative education in their standards (Harrison-Bernard et al., 2019). Thus, the target audience could be expanded to both educators and practitioners in occupational therapy, speech therapy, physicians, physician assistants, nursing, and athletic training to name a few.

Clark (1983) viewed media’s only influence on learning was cost and distribution. Clark (1994) further elaborated on this position by stating “If there is no single media attribute that serves a unique cognitive effect for some learning task, then that attribute must be proxies for some other variables that are instrumental in learning gains (p. 22). Essentially, pedagogy and instructional design are responsible for any achievement (Koehler, 2016). Additionally, he added the concept of the replicability test. Essentially, not one single media attribute can solely impact learning and if you find a media that impacts learning for a task you must ask yourself if another media would result in the same outcome (Clark, 1994). The replaceability test further supports his stance that instructional designers should chose the less expensive and most efficient way to deliver instruction since more than one media can be equally effective.

Kozma (1991, 1994) challenged this perspective by attempting to look at the relationship between media and learning in a more complex way. There is an agreement with Clark that media alone do not influence learning outcomes, but that it is a combination of the media’s attributes and the instructional method employed (Kozma, 1991). Kozma (1991) states below:

Essentially, media and instructional method are a complimentary process in learning outcomes.

In the 21st century, this debate continued with Hastings and Tracey (2005) stating that media does affect learning. Additionally, media comparison studies will not provide research to end the debate, but rather an understanding on how the different media affects learning should be the desired outcome in research. Modern technology must be considered in this debate. As stated by Hastings and Tracey (2005), “We believe modern technology has turned the delivery truck into a supersonic jet. We believe that the attributes of modern media, specifically computers, the Internet and the World Wide Web, are not replaceable and that they do affect learning” (p. 6). By reframing the original debate, the authors suggested research could focus on gaining further insight on how media impacts learning.

Technology as media has advanced physical therapy education by allowing a diverse number of individuals engage in learning for the high demands of the healthcare system (Koehler, 2016). These advances have given substance to both Clark and Kozma’s perspectives. For example, the blending learning model has expanded access to education by combining electronic media with various face to face activities. This delivery approach allows individuals to continue learning, despite being unable to be in a fixed location like traditional models. Additionally, there can be a cost-reduction benefit for students which favors Clark’s perspective on media (Kliger & Pfeiffer, 2011). With various combinations of electronic media, blended learning showcases how each learner is unique with different learning needs (Kliger & Pfeiffer, 2011). Blended learning, through event-based activities consists of synchronous and synchronous learning. Synchronous learning activities consist of instruct and student communication in real time, whereas asynchronous learning activities consist of no real time presence. Various event-based activities include face to face communication, selfpaced activities, discussion and virtual chats (Singh, 2003). As a result, blended learning, utilizing various media platforms and delivery can showcase the various learning needs of the student (Kliger & Pfeiffer, 2011).

Computer-assisted learning, can promote higher order thinking and increase student collaboration and communication (Hughes et al., 2018). This type of media can benefit health professionals by promoting interprofessional communication and contemporary technology skills to enhance life-long learning (Veneri & Gannotti, 2014). Student centered approaches such as problem-based learning or casebased learning also support an evolved view of this debate. Traditional lecture learning has been viewed as a more passive approach whereas student centered approach requires active learning. In Clark’s framework, the learner is more passive, where in Kozma’s framework the learner is actively engaged (Kozma, 1994). Active learning and student-centered approaches were studied by Bayliss and Warden (2011) between a traditional and hybrid learning model. Results of the study revealed that a hybrid student centered model improved test outcome on questions with higher cognitive domains than students receiving a traditional lecture delivery. However, students exposed to traditional lecture delivery demonstrated improve scores on questions assessing knowledge (Bayliss & Warden, 2011). It is suggested that knowledge-based questions do not require higher cognitive domain levels of thinking. Therefore, student-centered approaches utilizing computer-assisted learning can promote the level of learning that is desirable for development of students as autonomous practitioners (Bayliss & Warden, 2011). As clinicians, physical therapists need higher order thinking, therefore it is in fact the combination of media and instructional method that improve learning outcomes, in turn supporting Kozma’s perspective. Perhaps Clark’s perspective has become too narrow in terms of defining a cause and effect relationship with media and learning outcomes.

To further support the evolution of this debate, health care simulation has become a powerful instructional method to achieve learning outcomes for physical therapists (Sabus & Macauley, 2016). Benefits of simulation allows the individual to learn by “doing” a task that may be expensive or dangerous in real life (Aldrich, 2009). A mannequin can be programmed to mirror a real life situation so that students can practice skill development without causing harm while also receiving feedback (Thackray, 2015). Physicians have utilized simulation to promote lifelong learning and to improve performance in dealing with emergencies in anesthesia (Chopra et al., 1994; Issenberg et al., 1999). Simulation is not simply designed around the lab or mannequin (media), but grounded in instructional theory allowing a richer learning environment and promoting skill development in a safe manner (Sabus & Macauley, 2016). Additionally, interprofessional simulation can promote teamwork and collaboration and expose students to learning experiences with other health care professionals (Costello et al., 2017). For example, in the acute care setting, simulation can facilitate physical therapy competencies that may not be learned in a traditional lecture-based setting. Students enrolled in an acute care class in a doctor of physical therapy program demonstrated more confidence in interprofessional communication and enhanced understanding of this specific setting thus supporting the need for this type of media and instruction (Silberman et al., 2013). These learning outcomes cannot be reproduced safely via other media, thus opposing Clark’s reproducibility test. Simulation supports the evolution of this debate by Kozma (1991, 1994) and Hastings and Tracey (2005) by embracing the combination of media and instructional method and the impact of advancements of technology in the past decades on learning outcomes.

Will this debate ever be resolved? I am not sure, but I wonder even more if it matters. Clark’s position of media being a “mere vehicle” currently has not been proven wrong in terms of an isolated cause and effect relationship. However, as technology has evolved perhaps the debate on whether his perspective is right or wrong needs to end. Instead, future research needs to address how media affects learning. By understanding how media impacts learning, we can utilize a more effective combination of media and instructional methods. In summary, Hastings & Tracey state “media comparison studies are inherently flawed and support the argument that we must identify research designs that will provide answers to this question in significantly less time” (p. 8). Perhaps this reframing of the narrative will lead to a deeper or more advanced debate in instructional technology.