Learning by Doing through Programmed Instruction


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Learningby Doing through
PROGRAMM INSTRUCTIO

Programmedinstructioncan be compared with the tutorial method of teaching in which there is an exchange between the tutor and his student and a constant introduction
of new material as the student masters the previous material.
But, in programmed instruction there need not be a teacher. The ex-
change usually takes place between the learnerand the materialwhich is
arranged in steps of gradually increasing complexity-each one boxed in a "frame"-so that the learner can easily proceed from what he knows to new and more
complex materials. Each learner's response and his rate of progress is an individual affair; his responses are not conditionedor determinedby the responsesof others.
Programmedinstructionhas been used in elementary schools, high schools, nursing schools, colleges, and in industry. It has proved to be adaptable for various kinds of adult education.It is a teaching technique which holds great promise for the future-a technique which seems to be particularlyuseful for continuing
education.This articledescribesprogrammed instruction, gives several examples-one in physiology-and indicates some of its uses.

FRANCIS MECHNER
The applicationof behavioralscience to variousproblemsin educationhas resultedin somestartlinginnovations. One of these is the self-teachingtechniquecalled programmedinstruction.
Through specially designed programmedtexts, physiciansare keeping up with new developments in medicine;unskilledindustrialpersonnel are learninghow to operatecomplex equipment; trigonometry students are learning to do logarithms; illiterates are being taught to read and write; and detail men are learning to explain the chemical structure and clinical use of new drugs.
Basically,programmedinstruction involves the application of theories of learning to practical problems of education. Thordike at Columbia
and Watson at Johns Hopkins first suggested that the findingsof experimental psychologists should be applied to educationalpractice;Hull at Yale formulateda theory of concept formationin 1920 which proved to be extremely important, but it was Skinnerat Harvardwho laid most of
DR. MECHNER (Ph.D., Columbia University, New York, N.Y.) is director of research at Basic Systems, Incorporated, New York, N.Y. and is a consultant in behavioral technology to UNESCO.

the scientificgroundworkfor the de-
velopment of behavioraltechnology. The past five years have seen a remarkable burgeoning of interest in this new technology, and the use of programmed instruction in a wide variety of fields has resulted in more rapid and more complete learning than was achieved by other methods
of instruction, often with difficult,
technical material.
As the technology of programmed instruction evolved and matured, a
variety of methods and techniques
have developed.Obviously,postgraduate medicaleducationprogramswill lookvery differentfromprogramsdesigned for elementaryschool children, and both of these will look different
from programs designed to teach people how to listen moreeffectively. However, they all have certain characteristicsin common.
A very simple examplefollows. By doing the items at the top of the next page, you can teach yourself, in about two minutes, how to square, mentally,any numberending in five. Be sure you always write in your own answer before looking at the correct answer, shown in the right hand column. Cover the correct an-
swer with a piece of paper until you have written in your own answer.

98 MAY 1965

AMERICAN JOURNAL OF NURSING

QUESTIONS
1. Here is how you can square 15: 15 lies between 10 and 20 10 X 20= 200 + 25 =

I

I

QUESTIONS

4. Here is how you square 45:

45 lies between . . .

X

=

+

=

2. Here is how you square 35: 35 lies between 30 and 30 X 40 = 1200 + 25 =

3. Here is how you square 65:

65 lies between

and

X 70 =

+ 25 =

5. Here is how you square 25: 25 lies between...

X

-

Finish the example, mentally:

6. Here is how you square 75: 75 lies between..

7. Square 55, mentally
8. Square 85, mentally.
Another example of programmed instruction are the following excerpts from an already published program. Panel 3 (below) is referred to in the frames on the next two pages.

PANEL3

Ovarianand EndometriaAl ctivityDuringthe MenstrualCycle

VOLUME

65, NUMBER

VOL6U5N,MUEM5 BER 5

DAYSOF MENSTRUALCYCLE

MAY 1965 MAY 1965

99~~~~~~~~~~~~
99

_
PROGRAMMEDINSTRUCTION
5 TURNTO PANEL3 Panel 3 depicts the sequence of events in the ovary and endometrium during the menstrual cycle. Whatstructure is present in the ovary:
following ovulation? priorto ovulation? Whatis the phase of endometrialdevelopment: during the menses? following ovulation? immediatelypriorto ovulation? Whatis the phase of endometrialdevelopmentwhen a fertilizedovum could be present for implantation?
6
REFERTO PANEL3 As the. panel indicates, development of a corpus luteum within the ovary is followed by
7 DO NOT REFERTO PANEL3 LABELthe last step of the following sequence of events occurring within the ovary during the menstrual cycle:

GROWTHOF AN OVARIANFOLLICLE- OVULATION

DEVELOPMENTOF A CORPUS LUTEUM

8
REFERTO PANEL3 Withinthe ovary,the event that follows ovulationis The final phase in the development of the endometriumduring the menstrual cycle is the

100 MAY 1965

AMERICAN JOURNAL OF NURSING

9 DO NOT REFER TO PANEL 3 LABELthe missing steps in the followingdiagramsto indicate the sequence of events within the ovaryand in the endometrium:
GRO"TI-iH OF AN OARIAN FOLLICLE > OVULATION1-)

10
REFERTO PANEL3 Whateventwithinthe ovaryfollowsgrowthof an ovarianfollicle? In the endometrium,the phase that follows the menstrualphase is the

ovulation

11
DO NOT REFER TO PANEL 3 LABELthe missing steps in the followingdiagramsto indicate the sequence of events withinthe ovaryand in the endometrium:

'rO' .iTH OF A'i OVARiAN FOLLICLE --

MENSTRUAL PHASE -H
I

VOLUME 65, NUMBER 5

When the learner has completed the above frames and frames 12 through 21 (not included with these excerpts), he should be able to complete correctly test frames 22 and 23, shown on the next page.

MAY 1965 101

22

CHECKthe phase(s) throughwhich the endometriumpasses while the corpus luteum is present in the ovary:
O the menstrualphase
j the proliferatoryphase
n the secretory phase

23

^-

MATCHeach of the followingstages of ovarianactivitywith the phase(s) of the endometriumthat correspond(s) to it in time:

A. onset of menstrualphase

1.

B. duringmenstrualphase

C. end of menstrualphase

2.

D. onset of proliferatoryphase

E. duringproliferatoryphase

3.

F. end of proliferatoryphase

G. onset of secretory phase

4.

H. duringsecretoryphase 5. I. end of secretoryphase 6.

7.

degenerationof corpus luteum follicle reaches
maturity onset of follicle
growth onset of growthof corpus luteum ovulation
periodduringwhichcorpus luteum is present periodof follicle growth

As can be seen from these ex-
amples, the main features of programmedinstructionare:
1. Step-by-stepprogressionin complexity of material. Each step is a questionorproblemto which the student must make an active response before he can proceed. Because each step builds upon the knowledge taught in the previoussteps, the student is never required to answer a question about a subjectuntil he has learned the answer to it.
2. At each learning step, the student is required to make an active response.He is not the passive recipient of information;rather,he exercisesandpracticeshis knowledgeand skill as he acquiresit. He 'learns by
doing." 3. As soonas the studenthas made
his response to an item, he can find the correctanswerwhich is normally shownalongsidethe question.In this way the student is reassuredthat he is progressing satisfactorily.
Different learners will progress througha programat differentrates. In a group of thirty, the fastest learner may progress three times as fast as the slowest learner.With programmedinstruction,the fast learner is not held back by the slow one, and
102 MAY 1965

the slow learneris not left behind in a
state of helplessness and confusion. Also, learnerswho might be embarrassedto demonstratetheirignorance or show their failure to understand
in front of other personscan be "stupid" in private. When he is taking a program,a learnercan go at his own pace and make "silly"mistakeswithout anyone else knowing about it.
The varietyof programmingmethods and techniques currentlyin use are due to the varying requirements of different types of subject matter as well as to the differencesin learner
groups. Programsintended for children in the lower grades use shorter frames and smaller step sizes than those intended for childrenin higher grades. Programsin advanced areas, such as post graduatemedicaleducation, have frames which are sometimes an entire page in length, and which assume considerable prior knowledgeon the partof the learner. When the learner group is particularly heterogeneous,various branching devices, such as express stops, may be used. An express stop is a self-diagnostic frame, in which the learner is told that if he is able to
answera particularquestion,he may skip ahead to a specified point, but

if he is unableto answerit, he should proceed to the next frame. This is just one of several devices used to accommodateindividual differences.
Not all programmed instruction uses the paper-and-pencil response mode. The response mode must always be relatedto the type of behavior being tapght. For example, if the behavior to be learned is a conver-
sationalskill, then the programmust require spoken responses. If the behavior to be learned is typing, then the responses must be made on a typewriter.Some programsin industry use the audio-lingual mode to teach interpersonal skills, such as interview skills. In an audio-lingual program, the learner hears his instructionsand hears sample conversational exchanges on a magnetic tape or a record. He makes his responses orally, or by selecting an answer from several possible answers in a special response booklet.
In the early days of programmed instruction,a great deal of attention was focused on teaching machines. A teaching machine is primarily a device which exposes only one frame of the program to the learner at a time. When the learner has re-
sponded, he then is able to advance
AMERICAN JOURNAL OF NURSING

to the next frame by pushing a knob or button. The main advantage of a teaching machine is that it prevents "cheating"-peeking at the answer before having made the responseand unauthorized looking back at previous frames. But, machines are expensive,can breakdown, are difficult to move or carryaround,tend to slow down the student, and restrict the rangeof programmingtechniques that can be used. The trend in the
past few years has been away from teaching machines and toward programmedtext presentations,illustrated by the samples in this article. When the technical problems are solved and when costs are reduced,
it is quite possiblethat this trendwill be reversed, but this is not likely in the very near future.
Although programmedinstruction has not yet achievedthe samedegree of success in the school system that it has achieved in postgraduateeducationandin industrialtraining,there is every indicationthat it will eventually be used to a greaterextentin the classroom, especially if good programsbecomeavailable,and teachers learn to select and use them.
There is certainlyno lack of interest in this new technology among teachers. With some, this interest
arouses hope and expectation; with others, anxiety. Some teachers have voiced the fear that they may be
replacedby programmedinstruction, this fear is quite unjustified. Some teachers have assigned programmed instruction as homework. Other
teachershave used programsto help the class learn the basic subjectmatter, and then have used the remain-
ing classroom time for discussion, questions, and exchange of ideas. It has frequently been said that programmedinstructioncan take much of the drudgery out of teaching: grading homeworkis eliminated because programs do not need to be graded. Tests and examinationsbecome comparativelyless important, because students who have com-
pleted a programcan be counted on to have achieved the requiredlevels of knowledge. Professionally developed programs usually will produce medianfinalexaminationscores

of 90 percent, or better. Only those studentswho have not takenthe program can fail the final examination.
PRODUCINGA PROGRAM
As in any other technology, the productionof effective materialsrequires the collaborationof a team of
specialists. Beforea programcan be prepared,
the behavioralchanges that the programis expected to producemust be describedin detail. Programmersdo not talk about what the learner
should"understand"or"know"or"be
familiarwith."They talk aboutwhat the learnershouldbe able to do after
having completed the course that he could not do before: the questionshe should be able to answer, the problems he should be able to solve, the explanations he should be able to give, the diagramshe shouldbe able to draw, and the kinds of responses he should be able to make in given situations.These are all examplesof behavior. Once the behavioral out-
comes are known, productionof the programcan begin.
The initial step in the production processis called "taskanalysis."This is the identificationand description of the tasks which the student must
learn to perform in order to do his job or carry out the objective established for the program.
Task analysisrequiresthe collaboration of subject matter experts and behavioralpsychologists.The subject matterexpertsmust be familiarwith the problems of the occupation for which the learner is being trained, and must be able to identify the individual tasks that must be learned.
The psychologist (or "behavioral technologist") then insures that the descriptionof these tasks is specific, operational,and behavioral.He must be surethat the tasksare specifiedin terms of the situations that arise in
practice,andin termsof the responses which the learneris expectedto make in these situations.
The task analysis approach to planningthe teachingof subjectmatter will yield a syllabus which will be different from that which other
approachesmightyield. For example,

if one approachedthe development of a syllabusfora nursingcoursewith such questions as, "What topics shoulda nursestudy?"or"Howmuch physiology does a nurse need to know?",the syllabuswould be different from one developed by asking, "What are the situations and problems which a nurse encounters and
how should she cope with them?" This latter approachis the one taken by the behavioraltechnologistin carrying out a task analysis. However, this does not mean that theoretical
backgroundknowledge is neglected. When the behavioral technologist analyzesthe decisionsand judgments a nurse must make in order to cope successfullywith any particularsituation, he quickly discovers that the nurse needs theoretical background knowledge although many of the skillsshe uses arepracticalones. The behavioraltechnologist carryingout a task analysis works back from the tasks,which he and the subjectmat-
terexperthaveidentified,to the background material which must be masteredin orderto enablethe nurse
to cope with the tasks successfully. One significantfinding in a series
of taskanalysescarriedout in nursing is that amongthe nurse'smostcritical skills are those of an interpersonal nature. The nurse spends more time with the hospitalized patient than any other professional worker, and the patient often develops an emotionalas well as physicaldependence upon her. To some extent, the nurse assumes some of the functions nor-
mallyfulfilledby the patient'sfamily. It is not enough to say that a nurse musthave sensitivity,understanding, perceptionand the abilityto use herself in her interaction with the patient. These are skillsthat she can ac-
quire systematically.In programmed instruction it is the task analyst's responsibilityto work with the subject matterexpertto identify, define, and analyze the specific behavior needed by a nursein given situations so that she may then be taught some of the necessaryinterpersonalskills.
Once the task analysis has been completed,we know in generalwhat should be taught in the course. The next step is to describe these tasks

VOLUME 65, NUMBER 5

MAY 1965 103

PROGRAMMEDINSTRUCTION here in a broad sense; it could be an not have the advantage of consulting

interpersonal situation, a clinical sit- professional persons with many skills,

uation, or an ordinary stoichiometry is great indeed. These differences

in such a way that we can use the descriptions, known as specifications, as a test of whether or not a learner

problem. The behavioral technologist works out the precise steps to be
used, and later teaches these steps

show up not only in the teaching effectiveness of the program, but also
in the acceptability of the program to

has acquired the desired knowledge when he has completed the program being developed. The emphasis is upon behavior and the conditions under which this behavior is to occur.

through a self-instruction program. One example of teaching a series of thought steps is provided by the little arithmetic illustration on page 99.

the learners. If a program is expertly produced, a target group of learners should be able to complete it with relatively little effort and pain, and attain a median score of 90 percent,

The questions the learner should be able to answer, the problems he should be able to solve, and the situations with which he should be able

THE TEACHINGSEQUENCES
Once the behavioral objectives of the course have been specified, and the behavioral analysis has been com-

or better, on a final examination. Can a program be evaluated short
of testing it on a selected group of learners? A practical, but not really

to cope after having completed the course become the specifications of behavioral objectives. Examples of specifications of behavioral objectives are frame 7 on page 100, and frames 22 and 23 on page 102.
Next, the behavioral technologist examines these objectives and dissects them into their most minute

pleted, step-by-step instructional se-
quences, known as frames, can be developed. After the frames are prepared, the program is tested with learners who are typical members of
the target population for whom the program is intended. Invariably, some parts of the test program will be too easy, other parts too difficult, and

satisfactory way to examine and evaluate a program is to take the program. If the program quickly becomes tedious, boring, confusing, or
irritating, the chances are that some-
thing is wrong with it. Many programs require trivial or inconsequential responses from the learner, wasting his time and irritating him-the

behavioral components. He breaks them down into categories and classifications that make sense from a

many parts just confusing. The responses and reactions of the
testing group are used as a basis for

most common symptoms of inade-
quate behavioral analysis. If the program is confusing or ambiguous in

teaching standpoint. The behavioral technologist works in collaboration

revision. The revised version then is tested on another group of the typical

spots, the program probably was not subjected to enough testing and re-

with the subject matter experts. He needs the answers to detailed, specific questions from someone who knows the subject matter thoroughly. He may ask such questions as "What are some examples of concept X?" "Will the student confuse concept X with another superficially similar concept?" By asking questions of this
type the behavioral technologist obtains lists of examples and "non-examples," which can later be used in the concept formation process. When the learner later learns that a, b, c,
and d are all examples of concept X, and that e, f, g, and h, though they look like cases of X, are not cases of

learners. Again, the program is revised according to the test results. Usually three or four cycles of testing and revision are needed before a
program is considered complete.
Professional programming groups generally demand that a finished program enable learners who have completed the program to score 90 percent, or better, on a final examination which covers the material taught in
the program. Through repeated testing and revision, most of the rough spots in the program are eliminated. But it is not until the program meets the original specifications, and until most learners in the test groups are

vision. However, the evaluator may
find the program too easy or trivial because it was intended for a target
population with less knowledge; the evaluator simply knows too much. The only really valid way to evaluate a program is to try it out on members of the target population for
whom the program was designed. Programmed instruction may well
have a significant impact upon nursing education during the next decade. Already, programmed texts for
nurses are appearing with increasing frequency. Not all of these are good programs. But until nurses, as consumers of programs, are informed,

X at all (non-examples), but rather cases of Y, the psychologist says that the student is learning the concepts X and Y. During the process of analyzing the desired behavior, the behavioral technologist also asks such questions as "What is the first question the student should ask himself
when confronted with problem Z?", and "What are the detailed steps of the reasoning process which the student should follow when trying to solve Z?"The term "problem" is used

able to complete the program without ever being confused or getting stuck, that the program is released.
This is a simplified view of the production process. In practice, the process is quite intricate. Many specialized skills-the main determinants
of the quality of the final productare brought into play. The difference, therefore, between programs produced by experts and those pro-
duced by amateurs, particularly those who work alone and often do

discriminating, selective, and demanding, the characteristics and quality of the programs which are offered will continue to be uneven.
Like every other professional group today, nurses face an information explosion and must find ways to keep up with the accelerating pace of new developments. Against this background, programmed instruction holds considerable promise as an efficient, convenient, and accessible
method of continuing education.

104 MAY 1965

AMERICAN JOURNAL OF NURSING

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Learning by Doing through Programmed Instruction