Attitudes to and Uptake of Learning Technologies in Complementary Medicine Education: Results of an International Faculty Survey

Abstract

Objective:

The complementary medicine (CM) education sector is maturing as evidenced by rising professionalization and improved educational standards. However, despite the substantial size of the CM industry the education of existing and future CM practitioners has received little research attention. The aim of the study reported here is to explore the perceptions of CM teaching academics (working across the university and nonuniversity CM education sector) to the use of learning technologies in their work.

Methods:

An online survey was administered to academic staff (n = 80) at two key CM education provider institutions, one in Australia and one in the United States. Academics were questioned regarding four specific domains: their demographics; their perceptions and experiences of technologies in general; their perceptions of the changing face of CM education and the role of the CM teacher in general; and their perceptions of their institution's infrastructure, progress, and support regarding learning technologies.

Results:

Respondents reported having taught for a mean of 9.6 years overall and a mean of 5.3 years at their current institution. More respondents identified as female, and most participants were employed on duration-specific contracts (n = 57, 72.2%). A majority of permanent employees (71%) reported not currently being in clinical practice, while most contract employees (82%) were in clinical practice. Participants reported that teaching practice was changing due to the availability of learning technologies (mean 4.2: standard deviation [SD] 0.79) and that confidence and capability with digital technologies were essential to being a successful academic (mean 4.2: SD 0.74). Contracted academics were significantly more in agreement than the tenured academics with regards to their institution being more advanced with regards to the effective use of digital technologies (p = 0.025). Tenured academics were significantly more likely than the contracted academics to perceive themselves as having a positive influence upon recommendations for new technologies to be adopted by their institution (p = 0.001), as well as input to decision-making about which technologies are implemented in their area of work (p < 0.001).

Conclusion:

This in-depth empirical study of CM academics' perspectives provides novel but measured preliminary insights into the place and value of learning technologies in CM education. This research is consistent with other educational research suggesting that academics have complex patterns of technology adoption and that over simplified interpretations of resistance to change among academics require modification and should not be seen as the rejection of technologies by academics. Ultimately, more research exploring the interface of CM education and learning technologies is needed, including comparisons with staff and academic perspectives within and across other CM institutions, integrative medicine institutions, and medical education settings.

Background

Complementary medicine (CM)—health care not traditionally associated with the conventional medical profession or medical curriculum¹—houses a diverse field of mind–body practices (e.g., yoga, meditation), natural products (e.g., vitamins, herbal medicines), systems of medicines (e.g., Traditional Chinese Medicine, naturopathy, homeopathy), and treatments (e.g., aromatherapy, reflexology).² The uptake of CM is increasing worldwide³ as evidenced, for example, in Australia by practitioner visits^4
–6 and over the counter sales.⁷ In Europe and the United States the picture is very similar.^8,9 Yet despite the size of the CM industry and CM providers occupying a significant role in the Australian and U.S. health care settings,^10
–12 the education of CM practitioners has received little empirical attention.¹³

Meanwhile the educational sector has seen maturing research exploring changes in tertiary education (including but also beyond a health care focus) in response to developments in learning and digital technologies¹⁴ that include constructivist education theories, changing student learning behaviors,¹⁵ nontraditional students, and Massive Open Online Courses (MOOCs).^16

–20 While significant research attention has been focused on the theory and andragogy of online learning,^21
–23 questions remain about the use of new technologies and the possible implications and pressures for students, educators, and institutions, as well as conflicting views about the value and importance of technology that impact workforces in general.^24

–27 So embedded and normalized are digital technologies in contemporary tertiary education that they are often now considered “unremarkable” to educational researchers.²⁸ This notwithstanding, tertiary institutions remain challenged in their attempts to engage with the contemporary unsettling and challenging nature of new technologies and the expectations and demands of more recent students who have “grown up digital”^28,29 and who are reliant on digital technology in ways that earlier generations were not.

A recent critical integrative review of CM education³⁰ highlighted two key issues of significance for CM educational institutions, regulators, and researchers and pointed to a number of significant gaps in this area of research. First, there is very sporadic coverage of research in CM education. Second, the robust and mature research regarding educational technology and e-learning taking place in education more broadly and medical and allied health education research in particular are notably absent within CM educational research. Similarly, completely absent in the CM field is the recent research and discourse in education that has focused on the growing casualization (use of adjunct academics over tenured) of the workforce in academia,³¹ in faculty resistance to change, the digital divide between subsets of students and between students and faculty, and student readiness for online study.^32

–36 Despite the high levels of CM use in the community, and the presence of CM educational institutions globally, the current evidence evaluating the procedures, effectiveness, and outcomes of CM education remains limited on a number of fronts. There is an urgent need to establish a strategic research agenda around this important aspect of health care education with the overarching goal of providing important data and support for CM educational leaders, as well as ensuring a well-educated, effective CM health care workforce delivering quality clinical care. In response, this article reports on findings from a study exploring CM academic attitudes to and perceptions of the uptake of learning technologies in the United States and Australia to address some of the gaps previously identified in relation to CM academics.

Materials and Methods

Aim

The aim of this study is to explore the attitudes and perceptions of CM academics to the use of learning technologies in their work.

Study design

An online survey was administered to academic staff at two CM education provider institutions.

Setting

The sample institutions, an institution in Australia (Institution 1) and an institution in the United States (Institution 2), were selected as they represent two leading CM educational providers globally and cover the breadth of CM educational provision (undergraduate, postgraduate, medical, and professional CM offerings).

Sample

Academic staff within the two institutions were the target population. The survey was administered to all tenured, contracted, and adjunct academics at both institutions at the time of recruitment. It is estimated that Institution 1 administered the survey to ∼350 academics.³⁷ Institution 2 administered the survey to 180 academics. Administrative or research staff were not included in the sample population.

Ethics approval

Ethics approval for the project was obtained from the University of Technology Sydney Human Research Ethics Committee (ETH16-0477) and NUNM Institutional Review Board (#AG05052017).

Survey administration

A link to the anonymous online survey was distributed through e-mail invitation by a member of the senior leadership team at both institutions with two subsequent e-mail reminders. It was made clear to potential participants that completion of the survey was voluntary. Written consent was obtained before survey completion. Recruitment was conducted over 4 weeks in October 2017.

Instrument

The survey instrument was designed to explore four specific domains: demographics; attitudes to technologies in general, including their self-assessed technology adoption category; perceptions of the changing face of CM education and the role of the CM teacher in general; and perceptions of their institution's infrastructure, progress, and support regarding learning technologies. The survey was assessed for face validity before study recruitment by testing the instrument and receiving expert feedback. Instrument modifications were undertaken where relevant with regards to language clarity, use of different educational terms (as used internationally), the time required to complete the survey (12 min), and the relevance of questions.

Demographics

A number of survey items identified the respondent's current institution role or position, how many years they had been teaching at their institution, their gender, and current employment status.

Attitudes to technologies

Academics were invited to self-rate their perceptions of contemporary digital technology and the impact of this technology on their CM students. Participants were also asked to choose which category best matched the way they adopted technologies using the Diffusion of Innovation categories of Rogers,³⁸ a theoretical model that describes rates of adoption and perceived attributes of adopters.³⁹ Examples of where Rogers Diffusion of Innovations theory has applied in the field of education include education policy,^40,41 the provision and adoption of teaching online,⁴² online learning,⁴³ staff development in education,⁴⁴ faculty attitudes to technology,⁴⁵ faculty resistance to change,^46,47 and adoption of educational technology in general.^48,49

Perceived changes to education and the role of the teacher

Participants were asked to report their perceptions of whether teaching practice is changing and whether this is due to the availability of learning technologies, as well as how learning technologies impact both their activities in the classroom and their wider work as academics.

Perceptions of institutional infrastructure, progress, and support

A number of survey items captured respondents' perceptions and experiences regarding possible constraints upon the incorporation of digital technologies and digital learning into their own and institution-wide classroom activities and their own ability to influence and recommend new technologies in their workplace. Additional survey items explored respondents' perceived institutional support for change, challenges and barriers to adopting new digital tools, and also questioned if participants viewed their institution as more advanced in the effective use of digital technologies compared to other institutions. Attitudes to training opportunities for academics, as well as attitudes to the inclusion of digital literacy content in the institution's curriculum, were also explored.

Data collection

Data collection was administered online through SurveyGizmo. Following completion of data collection period both complete and incomplete data were transferred to spreadsheets for analyses. In addition, bias was minimized using established/pilot tested questions/instruments.

Statistical analysis

Descriptive statistical analysis was used, including frequencies and percentages for categorical variables and means and standard deviations (SDs) for continuous variables. Associations between categorical and continuous variables were examined using Student's t tests. Pearson chi-square tests were used to test for association between categorical variables. A p-value of <0.05 was applied to determine the level of statistical significance. To correct for multiple statistical testing, a modified Bonferroni correction was used.⁵⁰ Analyses were conducted using the statistical software SPSS Statistics.

Results

The survey was completed by 80 respondents providing a response rate of 15%. Table 1 summarizes the full details of the demographic features of academics at these educational environments who participated in the research. Respondents reported having taught for a mean of 9.6 years (SD 8.10; Min 1, Max 43) overall and a mean of 5.3 years at their current institution (SD 4.90; Min 0.5, Max 28). More respondents identified as female (n = 52, 65.8%), and most participants were contractors (n = 57, 72.2%). A majority of permanent employees (71%) reported that they were not in clinical practice. However, 82% of contractors were in clinical practice.

Table 1.

Demographics of Participants (n = 80)

Demographics	n	%
Staff member
Institution 1	67	83.8
Institution 2	13	16.3
Gender (n = x)
Female	52	65.8
Male	23	29.1
Prefer not to answer	4	5.1
Employment status
Permanent full-time	16	20.3
Permanent part-time	6	7.6
Contract/sessional teacher	57	72.2
Years teaching
0–5	26	32.5
5–10	21	26.3
10–20	25	31.2
20+	8	10.0
Years teaching at institution?
0–5	50	62.5
5–10	19	23.7
10–19	9	11.3
20+	2	2.5

	n	Mean	Std. deviation	Min	Max
Years teaching	79	9.6	8.1	1	43
Years teaching at institution	78	5.3	4.9	0.5	28

Attitudes to technologies in general

Many participants reported the digital-specific skills and attributes most important for students to achieve success in life as: judging the quality of information (mean 4.6: SD 0.63); understanding privacy issues (mean 4.6: SD 0.67); and behaving responsibly online (mean 4.5: SD 0.87) (Table 2). Presenting themselves online (mean 3.5: SD 0.89) and working with video and graphic content (mean 3.2: SD 0.92) were perceived by many academics as less important to students achieving success in life. Most respondents agreed that the use of digital technologies led to increased student abilities to share their work with a wider and more varied audience (mean 4.3: SD 0.73). There was strong agreement that compared to previous generations, contemporary students were more media literate (mean 4.1: SD 1.12) and have fundamentally different cognitive skills because of the digital technologies with which they have grown up (mean 4.0: SD 0.94). Some academics rated their students' ability to understand how online search results were generated as poor (mean 2.7: SD 1.06), and most considered the amount of information available online today as overwhelming for their students (mean 4.3: SD 1.03). Many participants reported that the internet enabled students to find and use resources that would otherwise not be available to them (mean 4.3: SD 0.81), but perceived search engines as having conditioned students to expect to be able to find information quickly and easily (mean 4.1: SD 0.72). Using Rogers Diffusion of Innovation classification to choose which category best matched the way they adopted technologies the respondents identified themselves as “early adopters” (n = 28, 35%) or “early majority” (n = 30, 38.5%), but not “laggards” (0%).

Table 2.

Academics Observations of Students and the Impact of the Internet in Complementary Medicine Education (n = 80)

	Mean	Std. deviation
How important do you feel each of the following skills is for your students to be successful in life?
Judging the quality of information	4.6	0.634
Understanding privacy issues surrounding digital and online content	4.6	0.668
Behaving responsibly online	4.5	0.874
Writing effectively	4.3	0.806
Finding information quickly	4.2	0.792
Communicating their ideas in creative, engaging, or interesting ways	4.0	0.792
Presenting themselves effectively in online social networking sites	3.5	0.898
Working with audio, video, or graphic content	3.2	0.929
What is the extent that you agree or disagree about impact of contemporary digital technologies on students?
Contemporary digital technologies allow students to share their work with a wider and more varied audience^*	4.3	0.734
The internet encourages learning by connecting students to resources about topics of interest to them^#	4.1	0.608
The availability of digital content has broadened my students' worldviews and perspectives	3.8	1.011
The multimedia content available online immerses students more fully in topics they study	3.8	0.907
Contemporary digital technologies encourage greater collaboration among students	3.8	0.944
Contemporary digital technologies encourage student creativity and personal expression	3.7	0.921
Contemporary digital technologies do more to distract students from schoolwork than to help them academically	3.0	1.031
What is the extent that you agree or disagree with these statements
Contemporary students are more media literate than previous generations	4.1	1.120
Compared with previous generations, contemporary students have fundamentally different cognitive skills because of the digital technologies they have grown up with	4.0	0.940
Digital technologies are creating an easily “distracted” generation with short attention spans	3.9	1.040
Contemporary students are too familiar with digital technologies and need more time away from them	3.1	0.988
Contemporary students are really no different than previous generations, they just have different tools through which to express themselves	3.0	1.064
Contemporary students are very skilled at multitasking	2.8	1.001
Contemporary students are more literate than previous generations	2.2	0.811
Overall, how would you rate your students on each of the following?
Ability to understand how online search results are generated	2.7	1.066
Ability to use appropriate and effective search terms and queries	2.7	1.093
Ability to use multiple sources to effectively support an argument	2.4	1.166
Ability to assess the quality and accuracy of information they find online	2.4	1.025
Ability to recognize bias in online content	2.2	1.099
Patience in looking for information that is hard to find	2.1	1.096
To what extent do you agree or disagree with the following statements?
The internet enables students to find and use resources that would otherwise not be available to them	4.3	0.814
Search engines have conditioned students to expect to be able to find information quickly and easily^*	4.1	0.720
The amount of information available online today is overwhelming for most students	3.8	1.036
The internet makes students more self-sufficient researchers who are less reliant on your help	3.0	1.104
Today's digital technologies discourage students from finding and using a wide range of sources for their research	2.8	1.138
Today's digital technologies make it harder for students to find and use credible sources	2.7	1.184

Self-reported technology adopter category	n	%
Innovator	9	11.5
Early adopter	28	35.9
Early majority	30	38.5
Late majority	11	14.1
Laggard	0	0

All questions received at least one minimum score in the scale 1 (strongly disagree) and one maximum score 5 (strongly agree). The exceptions were # which denotes questions where the response range was from 3 (neutral) to 5 (strongly agree) and ^* which denotes questions where the response range was from 2 (disagree) to 5 (strongly agree).

Perceptions of the changing face of education and the role of the teacher

Most participating academics disagreed with the statement (Table 3) that avoiding technology in their CM academic work was to be preferred (mean 2.1: SD 1.03). Participants reported that teaching practice is changing due to the availability of learning technologies (mean 4.2: SD 0.79) and that confidence and capability with digital technologies are essential to be a successful academic (mean 4.2: SD 0.74). Furthermore, respondents reported modifying their teaching and assessment and directed students in class time to specific online resources, which are most appropriate for student assignments (mean 4.1: SD 0.84). Many academics devote class time to teaching the critical skills necessary to improve the reliability of information found by students online (mean 3.9), how to conduct research using the internet (mean 3.5: SD 0.97), improve and refine search terms and queries (mean 3.4: SD 1.05), as well as discuss with students how search engines work and how search results are generated and ranked (mean 2.8: SD 1.10). Some CM academics reported developing research questions or assignments that require their students to use a variety of both online and offline sources (mean 3.4: SD 1.18). Academics also report that the internet and learning technologies have a negative impact and require more and harder work from them as a teacher (mean 3.7: SD 1.18). These challenges include but are not limited to needing to monitor and manage student behaviors in the classroom, diminishing attention spans, poor academic writing skills, and search engine strategies. Overall, with regards to knowledge about how to use digital technologies (such as the internet e-mail, social media and social networking sites, and technology devices such as tablets, computers, smartphones, or gaming systems), most respondents reported their knowledge level as about equal to that of their students (n = 44, 55.7%), while some reported their students as usually knowing more than them (n = 22, 27.8%) and only a few academics reported knowing more than their students (n = 13, 16.5%).

Table 3.

Complementary Medicine Academics Perceptions of the Changing Face of Education and the Role of the Teacher (n = 80)

	Mean	Std. deviation
What is the extent that you agree with the following statements?
Teaching practice is changing due to the availability of learning technologies^*	4.2	0.795
I perceive confidence and capability with digital technologies as essential to be a successful academic in my area	4.2	0.749
At work, I'm enthusiastic about using new technologies^*	3.7	0.831
Institutional technology projects generally succeed at improving my job	3.3	0.773
I feel that I can influence and recommend new technologies that will be used by my institution	3.1	1.042
Worries about privacy and data protection have restricted the use of digital tools in my area of work	2.5	0.943
I feel that I have a say in choosing which technologies are implemented in my area of work	2.5	1.184
I am concerned that using digital tools will have a negative impact on my work–life balance	2.3	1.055
Concerns about my professional image have impacted my use of digital tools at work	2.3	0.989
In the past implementing new technologies has been a negative experience and impacted my job	2.3	0.996
If there is another way, I would actively prefer to avoid using technology	2.1	1.039
To what extent do you agree or disagree with the following statements?
I direct students to specific online resources which you feel are most appropriate for their assignments	4.1	0.848
I spend class time discussing with students how to assess the reliability of information they find online	3.9	0.976
I spend class time discussing with students how to generally conduct research using the internet	3.5	1.025
I spend class time helping students improve their search terms and queries	3.4	1.055
I develop research questions or assignments that require students to use a variety of sources, both online and offline	3.4	1.189
I spend class time discussing with students how search engines work and how search results are generated/ranked	2.8	1.104
I give my students research assignments in which they are not permitted to use online search engines	1.8	1.040
What impact has the internet and other digital technologies had on your teaching practice?
Giving you access to more material, content, and resources to use in your teaching	4.7	0.629
Allowing you to share ideas with other educators: with regards to each of the following^*	4.2	0.782
Enabling better interaction with your students: with regards to each of the following	4.2	0.935
Increasing the range of content and skills you need to be knowledgeable about^*	4.5	0.669
Generally requiring more work for you as a teacher: with regards to each of the following	3.7	1.189

How is your knowledge of digital technologies compared to your student's	n	%
I usually know more than my students	13	16.5
My students usually know more than I do	22	27.8
Their knowledge levels are usually about equal	44	55.7

All questions received at least one minimum score in the scale 1 (strongly disagree) and one maximum score 5 (strongly agree). The exceptions were ^* which denotes questions where the response range was from 2 (disagree) to 5 (strongly agree).

Perceptions of institutional infrastructure, progress, and support

Academics commonly perceived their students as having adequate and sufficient access to the internet and other digital technologies to effectively complete college/university assignments (mean 3.9: SD 0.92) (Table 4). However, many participants reported seeking out opportunities, separate to those provided by the institution to learn more about incorporating digital technologies into their teaching (mean 3.6: SD 0.98). Some CM academics reported using a greater range of technology in their personal life than is available at their institution (mean 3.1: SD 1.10). Some participants reported a lack of technical support to use digital technologies consistently—such as repair, troubleshooting, and setup—provided by their institution (mean 3.0: SD 1.20), while others reported feeling hampered by time constraints in incorporating digital technologies and digital learning into classroom activities (mean 2.9: SD 1.10) and pressured to teach to assessments (mean 2.8: SD 1.22). Academics from both countries perceived their institution as lagging behind in using digital technologies effectively compared with other education institutions more broadly (mean 2.7: SD 1.04). Only a few participants agreed that their institution did a good job providing teachers with the resources and support necessary to effectively incorporate the newest digital technologies into curriculum and andragogy (mean 2.6: SD 1.21), and few agreed that there was enough training in how to incorporate digital technologies into the learning process (mean 2.1: SD 1.14). Respondents did not perceive the challenge to incorporating digital technologies in the classroom as being a result of their own lack of comfort, knowledge, or training with these technologies (mean 2.3: SD 1.19).

Table 4.

Complementary Medicine Academics Perceptions of Institutional Infrastructure, Progress, and Support (n = 80)

	Mean	Std. deviation
To what extent do you agree or disagree with the following statements?
Courses or content that focus on digital literacy should be incorporated into the College curriculum^*	3.9	0.834
Students have sufficient access in College to the internet and other digital technologies they need to effectively complete school assignments^*	3.9	0.921
It is necessary to manage students' use of cell phones and other technology in your classroom	3.6	1.243
Have you ever sought out opportunities, separate to those provided by the College, to learn more about incorporating digital technologies into the learning process	3.6	0.984
It is imperative for schools to teach and assess today's students using the digital technologies they are most comfortable with	3.3	0.953
I use a greater range of technology in my personal life than is available at my institution	3.1	1.109
There is a lack of technical support (such as repair, troubleshooting, setup) to use digital technologies consistently	3.0	1.234
I am hampered in incorporating digital technologies and digital learning into my classroom activities by time constraints	2.9	1.105
I would like to incorporate digital technologies and digital learning into my classroom activities but I am pressured to teach to assessments	2.8	1.221
When it comes to incorporating digital technologies and digital learning into your classroom activities there is general resistance by colleagues and administrators	2.7	1.060
Compared with other colleges, their College is more advanced when it comes to using digital technologies effectively	2.7	1.047
Their College does a good job providing teachers the resources and support needed to effectively incorporate the newest digital technologies into College curriculum and pedagogy	2.6	1.219
My own lack of comfort, knowledge, or training with digital technologies is a challenge in incorporating digital technologies in the classroom	2.3	1.196
There is a lack of resources and/or access to digital technologies among my students	2.3	1.095
Their college currently provides teachers with formal training in how to incorporate digital technologies into the learning process	2.1	1.146
To what extent do you agree with these statements related to the challenges and barriers to adopting new digital tools?
My institution is supportive of new technologies and teaching tools	3.8	1.025
Does your institution support personal digital tools you use in your teaching work	3.2	0.964
Training for new digital technologies is rarely available at my institution	3.1	1.110
I cannot implement change due to budget constraints	3.0	0.864
My institution has formal process for communicating ideas to management for implementing new digital tools	2.9	1.070
Time is made available to explore the use of new digital tools at my institution	2.5	1.091

	n	%
Highlight the types of assistance you would seek when faced with a new digital technology you must learn
My supervisor or another knowledgeable lecturer on the topic	45	72.4
Another College resource	30	51.7
A friend or another research student	23	37.9
A coworker	35	58.6
A family member	14	24.1
Online an online tutorial, user guides, or question forum	46	77.6
I would not look for assistance I would just try to work it out for myself	15	25.9
Which resources of the College have helped you to develop/strengthen your digital technologies, skills, and capabilities
I do not feel that any resources of the College have helped me to develop or strengthen my digital technology skills	21	29.3
One-to-one sessions with my supervisor or other	23	32.8
Lecturers	14	22.4
Computer software obtained through the College which I use on my personal computer	11	19
Shared computer laboratories at the College	3	5.2
IT services	22	36.2
The Library	21	34.5
Workshops or other lecture sessions conducted by lecturers or staff in my department	14	22.4
Workshops or other lecture sessions conducted by someone from outside my department	13	22.4

The relationship between academic's employment status, clinical practice, and attitudes to and uptake of learning technologies

Inferential statistical analysis found clear differences between those participants in clinical practice and those not in clinical practice, and between those tenured and contracted, and their attitudes to learning technologies using α = 0.05. It is to be noted that the current study's analysis did not differentiate between private clinical practice and faculty clinical supervision. Compared with the tenured academics (i.e., those on permanent contracts), casual contract academics more commonly held the view that their institution is more advanced when it comes to using digital technologies effectively (p = 0.025). Casual contract academics also agreed more strongly than tenured academics that their institution has a formal process for communicating ideas to management for implementing new digital tools (p = 0.013) and that their own lack of comfort, knowledge, or training with digital technologies is a challenge in incorporating digital technologies in the classroom (p = 0.047). In contrast, tenured academics had attitudes that were significantly more in agreement than contracted academics regarding if they can influence and recommend new technologies that will be used by their institution (p = 0.001), if they have a say in choosing which technologies are implemented in their area of work (p < 0.001), if they currently develop research questions or assignments that require students to use a variety of sources, both online and offline (p = 0.013), and if there is a lack of technical support at their institution (such as repair, troubleshooting, and setup) to use digital technologies consistently (p = 0.007). In addition tenured academics were significantly more in agreement compared to contracted academics about the necessity for the incorporation of courses or content that focus on digital literacy into the College curriculum (p = 0.045) and that digital technologies allow academics to share ideas with other educators and have had an important impact on their teaching practice (p = 0.027).

Those respondents that identified as also being in clinical practice were more likely than the academics not in clinical practice to perceive that: the availability of digital content has broadened their students' worldviews and perspectives (p = 0.030); compared with previous generations contemporary students have fundamentally different cognitive skills because of the digital technologies to which they have been exposed (p = 0.027); behaving responsibly online is a necessary skill for students to be successful in life (p = 0.035); contemporary digital technologies encourage student creativity and personal expression (p = 0.039); and their institution has a formal process for communicating ideas to management for implementing new digital tools (p = 0.010). Those academics surveyed that were not in clinical practice were more likely than those in current practice to perceive that: they could influence and recommend new technologies that will be used by their institution (p < 0.001); they have a say in choosing which technologies are implemented in their area of work (p < 0.001); training for new digital technologies is rarely available at their institution (p = 0.047); and they direct students to specific online resources which are most appropriate for their assignments (p = 0.039).

Discussion

The current study reveals four key findings which suggest that CM education settings are not exempt from the trends found in other educational environments with regards to learning technologies. Existing research previously highlighted the pressures, tensions, and impacts of technologies on the working lives of academics in many diverse learning environments from university academics in general⁵¹ to becoming an online academic⁵² and from andragogy⁵³ to blended learning.⁵⁴ One core issue identified in the current study—faculty resistance as a significant obstacle and challenge to change in the workplace—has been repeatedly identified elsewhere.^16,55 However, the current study's findings challenge some commonly held perceptions about academics and change that differ from previous studies in other educational settings⁵⁶ and suggest that CM educational environments may require a more nuanced approach with regards to understanding changing teaching practices, sense of value, and support.

Based on this study's findings, CM academics perceive themselves to be “early majority” adopters of innovation and as being proactive in their teaching and assessment delivery, such as devoting class time to discussing the reliability of information found online and how to conduct research using the internet. This finding potentially challenges widespread assertions that academics are simply resistant to change^57
–59 and instead is more congruent with studies in other educational settings such as science, technology, engineering, and mathematics^60,61 where it has been found that a combination of more digitally literate students plus the introduction of new internet technologies has resulted in development of new assessment approaches such as reflective assignments and e-portfolios.⁵⁶ However, as these survey data are self-reported and as academics' perceptions may not fully align with actions in the classroom nor with student perceptions the extent of resistance to change remains unknown.

Despite an apparent readiness to adopt technology, this study's findings suggest that CM academics perceive technologies to have a substantial detrimental impact on their students' future workplace skills, knowledge, and attributes. This finding emerged from answers to questions such as perceptions relating to student's ability to understand how online search results are generated, use effective search terms and queries, use multiple sources to effectively support an argument, assess the quality and accuracy of information they find online, and recognize bias in online content. Academics generally agreed that digital technologies had created an easily “distracted” student with a short attention span that was too familiar with digital technologies and needed more time away from them and that search engines have conditioned students to expect to be able to find information quickly and easily. This finding is similar to that identified in other educational settings such as journalism.^62,63 In the CM settings examined in the current study, academics expressed empathy to modern student predicaments given the sheer volume of data available to them, but rated students' ability to understand how online search results are generated in this “search engine society” as extremely poor.⁶⁴ Similar to the findings of the current study, existing research has drawn attention to the need for students to develop the ability to discriminate based on the quality and accuracy of available online information.⁶⁴ Equally, concerns raised by academics in tertiary education settings have focused on the generational difference in students' expectations and attention spans resulting from high engagement with online content and technology.^65

–68 These concerns were also evident in the responses from participants in the current study.

The current study's research highlights that CM academics (and especially contracted academics) feel strongly that they have limited control over the choice of technologies utilized in their teaching work. The findings point to a possible alignment with existing research describing the perceptions of contracted academics in broader academia.⁶⁹ This previous research points to inequities and inefficiencies compared with tenured staff and suggests that contracted academics feel their talent and ideas are underutilized and experience marginalization and disempowerment working within their institution. In broader educational research⁷⁰ the trend to “casualization” that continues to divide the educational workforce has received attention.^31,71,72 This existing research in other academic settings shows that casual (contract or adjunct) workers have often been relegated to an “underclass” that experiences more job insecurity, lower wages, and poorer working conditions.⁷³ Furthermore, research in wider education circles has also highlighted that in general there are often fewer processes in place for identifying, documenting, and creating meaningful policies and practices for this contracted faculty population.⁷⁴ Further research is needed before effective strategies can be established for marshalling institutional resources, appropriate training, more regular allocations, and inclusion in formal academic processes to redress this reported perception among CM academics of marginalization with regards to learning technologies.

Existing research that provides examples of the successful adoption of technologies in educational settings has found that specific circumstances should be present to ensure such success.^75,76 This includes a need for an institutional strategy,⁷⁷ high-level champions supportive of change,⁷⁸ structures and supportive decision making that take into account faculty technology adoption status,⁴⁶ faculty willingness for change,³⁹ as well as sufficient resources and guidance supported by a varied program of staff development and opportunities.⁷⁹ In other educational settings, when the majority of faculty have articulated similar or the same negative perceptions to those expressed in this study (their institution is less advanced than others, students are given priority and are better resourced than academics, training is ineffectual, there is poor institutional technology supported, and few formal processes for communication upward, restricted by time and budgetary constraints), an urgent need for a strategy of deployment and training has been identified.^57,80
–82 A core finding of the current study is that most CM academics place the responsibility for any digital shortcomings squarely with their institution, not themselves. They report themselves as early adopters, rank themselves as mostly equal in their technology and knowledge levels to their students, and use a greater range of technologies than are available at their institution. This important finding in the current study possibly indicates that successful implementation of meaningful digital change may not be fully possible.⁸³ In broader educational research it is known that part-time employees and adjunct academics typically include a spectrum of faculty associates, lecturers, clinicians, and graduate assistants, and different types of instructors have different motivations for adopting technology with most faculty adopting a “wait and see” attitude.⁶⁹ For education leaders in these CM settings training should not necessarily be limited to full-time faculty but extended to part-time instructors to set examples to other potential adopters.⁸⁴ This acknowledgment of the breadth of digital competence of faculty may hold important strategic significance for CM educators and leaders in planning, training, and resource allocation in CM education settings.

Limitations

The limitations of this study must be acknowledged. Participants self-selected and, as such, possibly contributed to the selection bias whereby CM academics that have equally strong or stronger attitudes to learning technologies and practice enhancing technologies chose not to complete the survey. Both CM institutions had students of similar age, subjects offered, and gender balance but there are important differences between the institutions, including size and the mode of study. While teaching similar courses and subjects (e.g., nutritional medicine), the unique characteristics of Institution 1 (multiple campuses, Australian, undergraduate, nonmedical CM courses) and the unique characteristics of Institution 2 (single campus, United States, postgraduate, medical courses) limit the transferability of findings to other institutions in both Australia, United States, and further afield. In addition, as it was only a small proportion of academics that chose to participate from one institution this meant that there is little value in reporting comparative statistics between the two institutions. The effects of potential random error could be due to the small sample size within the study. Importantly, the small sample size limits the generalizability of findings. Despite these limitations, the results from this research provide valuable insights into CM academic perspectives and experiences regarding learning technologies and highlight the need to further research key aspects of CM education provision. As such, the perceptions of academics regarding technologies and learning at other CM institutions warrant further investigation and comparison with these findings.

Conclusion

This in-depth empirical study of CM academic perspectives and experiences presents novel but measured preliminary insights into the place and value of learning technologies in CM education. This research is consistent with other educational research suggesting that academics have complex patterns of technology adoption and that over simplified statements by researchers in education about resistance to change require modification and should not be seen as rejection of technologies by academics. The examination of CM student perceptions would serve to create further clarity in this emerging field as would research regarding use of technology as it relates to the methodologies of teaching CM to more deeply understand recruitment, retention, and development of faculty teaching within CM to enable graduates to better utilize CM in clinical practice. Moreover, further research is also warranted to explore the perceptions and experiences of broader CM education staff and CM academic researchers at other CM institutions, integrative medicine educational institutions, and medical education settings, to help identify and ultimately address the challenges, risks, and tensions around learning technologies in CM educational settings.

Footnotes

Author Disclosure Statement

All authors declare no conflict of interest. Affiliations at the time of research—A.C.G. was previously employed at Institution 1, 2008–15 but not at the time of data collection or analysis. A.S. was employed in a position with seconded responsibilities at Institution 1 at the time of the data collection.

Contributors

A.C.G. led the development of a study, conducted the study, and drafted the article. A.S. provided expertise on all stages of the study and revised article. J.A. provided expertise on all stages of the study and revised article.

Funding Information

Neither institution provided funding for this study.

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