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Implications of a new form of online education

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Massive open online courses were developed to offer universal free access to high-quality higher education, and may offer new opportunities in nurse education


This article discusses the development of massive open online courses. It examines the benefits and potential problems associated with this method of education delivery and describes how these courses are influencing nurse education. It also explains how changing delivery methods and access to higher education may alter how nurses engage with higher education in the future.

Citation: Parkinson D (2014) Implications of a new form of online education. Nursing Times; 110: 13, 15-17.

Author: Denis Parkinson is lecturer in nursing at the University of Liverpool.


Massive open online courses (MOOCs) are a new form of education delivery that aims to promote active learning and develop educational communities incorporating thousands of students. They have the potential to alter fundamentally the way nurses access and undertake higher education.

MOOCs originated in the US. Their growth has generated much discussion and debate about methods of teaching, the democratisation of education and the emerging possibility of accessing education free of charge (Harney, 2012).

Nurse educators need to be aware of and be prepared for the potential disruption to the status quo, while nurses need to think about how MOOCs may affect the way they choose and access continuing professional development.

This emerging method could increase the scope of educational opportunities available to practising nurses in the future, leading to greater choice and educational autonomy.

Development of MOOCs

MOOCs emerged from the areas of open educational resources and distance learning; the first was a course on artificial intelligence delivered by Stanford University, which attracted 160,000 students from 190 countries (Graham, 2012).

Sebastian Thrum, one of the academics involved, formed Udacity, a for-profit company set up to deliver MOOCs (Marques, 2013); within a year, two more companies entered the market - the not-for-profit EdX, set up by Harvard University and the Massachusetts Institute of Technology (MIT), and Coursera, another for-profit organisation. These companies, known as the “big three” MOOC providers, form partnerships with universities to develop and deliver their courses (New York Times, 2012).

The first MOOC produced by EdX, on circuits and electronics, attracted 155,000 enrolments although, as has become characteristic of MOOCs, only 7,157 students successfully completed the course.

MOOC providers are now emerging outside the US. Futurelearn, a MOOC provider set up in the UK by the Open University, has partnerships with 20 UK universities, the British Library, the British Council and the British Museum. Courses have been available through Futurelearn since September 2013 (McGettigan, 2013).

MOOCs cover a large and growing number of subjects (Box 1). Typically, courses involve a series of short online video lectures, which may be followed by multiple-choice questions to allow instant feedback. Assessment often involves multiple-choice tests, which are machine-marked, and essays that are self-marked and peer-marked. An overall score is awarded to students who complete the work set.

Students’ learning is supported by online discussion boards and social media. Online group discussions are facilitated by university teaching staff, although their direct involvement is often limited. A certificate of accomplishment is generally provided free of charge, although there are paid options providing a more individualised record.

Benefits and problems

One possible benefit offered by MOOCs is flexibility; students are not limited by time, geography or educational setting, while courses can be delivered in multiple languages.

A report by Universities UK (2013) has highlighted the role of MOOCs as “tasters” for more formal education. There is also the potential to use them for the development of lifelong learning skills and to support individuals’ continuing professional development.

Criticisms of MOOCs have related to several areas.

The large numbers of students using MOOCs can lead to online interaction becoming chaotic and difficult to manage or follow, while students need high levels of digital literacy for even minimal involvement with MOOCs; this may exclude individuals who do not possess the requisite skills and hardware. Students do not have access to university facilities and support services while undertaking a MOOC, and the large numbers of students mean that one-to-one interaction between student and teacher is unlikely.

Questions have arisen about the quality and international comparability of MOOCs, and it is unclear how the value of individual courses will be judged within disciplines that require people to meet professional as well as academic standards.

The question of MOOCs attracting university credits is becoming a common discussion topic. Udacity has launched courses accredited by San Jose University and legislation within California may require universities to recognise approved Coursera courses (McGettigan, 2013). Some argue that this development may lead to covert privatisation of some education by legitimising the relationship between “for profit” MOOC providers and universities, as through legislation a revenue stream could be established involving public funds (Vernon, 2013).

While MOOCs may seem to offer universal access to higher education, research from Columbia University suggests that underachieving, minority and disadvantaged students perform less well on online courses (Vernon, 2013). As many MOOC students seem to be already educated and interested in internet culture, MOOCs may actually exclude some students who lack education or an interest in internet culture, leading to various tiers of educational access. This is ironic, as the philosophy behind MOOCs was to offer free open access to leading universities and teachers.

Although no overarching business model has emerged to generate revenue from MOOCs, several potential avenues are being explored (Korn, 2013). These include the following:

  • Paid for;
  • Individualised certification;
  • Commercial use of students’ performance as a recruitment tool for employers;
  • Secure assessment to give credibility to the achievement;
  • Sponsorship;
  • Tuition fees (Matusky, 2013);
  • Textbook sales (Howard, 2012).

MOOCs and nurse education

Technological advancement is likely to provide even more opportunities for non-traditional delivery of education. MOOCs may alter the delivery of nurse education (Bellack, 2013).

As nursing remains a profession with diverse practitioners and working patterns, a move to more flexible and accessible modes of educational delivery will be of interest to nurses wanting to develop through continuing education.

Most MOOCs focus on technical subjects such as maths and computer science (DeSilets, 2013a), although they are expanding to cover subjects that are less straightforward to assess. Subjects integral to nurse education are becoming more readily available including physiology, public health, nutrition and clinical problem solving (Bellack, 2013).

Courses specifically relevant to nursing are now being offered by several universities in the US (DeSilets, 2013b). Of particular interest is an introductory course for nurses who wish to earn a bachelor’s degree at the University of Texas Arlington. This free course has led to a high percentage of students returning to enrol and pay for a second course, and demonstrated the potential to use MOOCs as a student recruitment tool.

While pre-registration nurse education in the UK has moved to all-degree provision, there has also been an increase in demand for courses that are not accredited by universities. Professional development courses for mentorship, for example, do not have to be part of a degree programme to meet the need of practising nurses. If MOOCs are quality assured and aligned with professionally approved learning outcomes, they could fill a need for short, specific, professionally orientated education benefiting both individual practitioners and healthcare employers. This would offer universities potential market growth and brand recognition on a wider scale than was previously possible, while nurses would be able develop skills to improve patient care through high-quality and flexible continuing professional development.

MOOCs may lead to larger classes accessed by a more diverse group of students, both within the profession and as a preparation for joining it. Online interaction between nurses on a large-scale, international basis could lead to greater understanding, cooperation and sharing of experience.


Although MOOCs have drawbacks, they demonstrate potential to deliver advantages. Every new development can be disruptive, and MOOCs may prove to be just one educational tool among many, but nursing needs to be involved with the process if it is to influence and understand the outcome. New developments that expand learning opportunities should be considered carefully by the profession for their potential to improve nursing, nurse education and above all patient care.

Key points

  • Massive open online courses were developed to offer free access to leading universities and educators
  • Although currently free to access, providers are beginning to charge for certification and looking for other sources of revenue
  • Students can interact with each other online while working through MOOCs, but access to academic staff is limited
  • MOOCs could be developed to provide continuing professional development for nurses
  • MOOCs offer universities a new method of recruiting students 
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Readers' comments (1)

  • There are several issues needing to be sorted out. Having a central access point for all health related MOOCs would help. I tried to look for what's available, is difficulty to find things. Validity & reliability will be the issue with them if used for professional credibility, as will appropriateness - will a USA practice MOOC be relevant for a UK based nurse for example?

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