Introduction

Incorporating technology usage within Saudi university education is an initiative of relatively new
provenance and one that has been struggling to secure rights and recognition, similar to how a new
country struggles to establish internationally recognized sovereign boundaries.1 It has been suggested
that the application of technology should indeed encouraged and even be incorporated, routine part of
students' daily activities within clinical activities and basic sciences.2 The most important element that
supports the use of technology in the educational system is the Internet. E-learning has become one of
the fastest-moving trends in education and poses a promising alternative to traditional learning.3 Studies
have shown that people learn considerably better from a combination of both words and images (which
technology enables) than merely from words alone.4 Technology helps students become independent,
proficient member and researchers.

The changing role of physicians in the new health care environment provides a stronger impetus than
ever before for these ideas to be incorporated. Nevertheless, using technology in the classroom is a
methodology not widely implemented in Saudi universities. Abouchedid and Eid stated that “The
overwhelming traditional knowledge delivery system for higher education in the Arab world
demonstrates the pronounced information (IT) gap between Arab countries and the developed world”.5

Research has indicated a need to change and revise the curriculum within health colleges to cope with
this revolution in technology6 because technology is becoming a highly important source of maintaining
currency and gaining knowledge within the health profession.7 Research has demonstrated that
smartphone applications and the Internet are introducing a new degree of responsiveness and flexibility
within educational processes. This responsiveness is facilitated by the ease with which content can be
updated, instruction can be personalized, information can be accessed, information can be distributed,
and content can be standardized.7 and 8

Increased implementation of technology will increase students' comprehension of content and

development of skills in such areas as analytical reasoning, problem solving, information evaluation, and
creative thinking.9 In KSA, there is a dire dearth and paucity of information regarding the effect of
technology usage on learning achievement. Rather, studies conducted within KSA have found that
students are used to a comparatively more traditional model of learning.6 and 10 However, the
comprehensive use of technology would create a good environment facilitative of learning. This
approach would shift education from the classical approach (which has not prioritized students' pursuit
of understanding) toward the deep-meaning approaches that would help students seek a true
understanding of the central principles, themes, and applications of any given area of study.11 Using
technology would support the active learning of students in an educational environment designed to
help students achieve meaningful learning – which, in turn, could result in positive, cumulatively
progressive gains in learning outcomes.12

Technology has been argued as having a positive impact on our way of thinking. Steve Johnson (2005), in
his nationally bestselling book Everything Bad is Good for You, posited that technology is making us
more intelligent due our means of obtaining, interpreting, and processing information. Many studies
have discussed how technology affects our brains and impacts how much its use affects the way that we
think and perform. 13 and 14

The present study involves physiology courses taught in five University of Dammam colleges of health:
The College of Medicine, College of Dentistry, College of Nursing, College of Applied Medical Sciences,
and College of Clinical Pharmacy. Lectures using PowerPoint presentations are used regularly in the
classroom. The presentations are then uploaded on Blackboard (an online system). Course websites
function as resource centres, providing access to all related documents along with links to additional
resources, as well as group e-mail lists and an interactive discussion board. In addition, AD instrument
recordings have become an integral component of laboratory teaching sessions, making them
comparatively more interactive and even more valuable learning experiences than previously.15

The present study's principle aim was to identify the impact of technology usage on student learning
achievement in the physiology courses taught in five colleges of health. The study attempted to answer
the following research questions:

1.

Is there a relationship between students' use of technology and their achievements in physiology
courses in the health colleges?

2.

Which device is most used by participating students?

I began my career in higher education in 1968, teaching lower-division chemistry at a brand new
community college. Of course, I had previously been a teaching assistant while I was earning my
bachelor’s and master’s degrees, but as a founding faculty member at Butte College in California, I had
free reign to design the curriculum, select the textbooks and lab manuals, decide which lab experiments
and activities to schedule, and what the sequence of topics would be. I tried to engage my students as
much as I could in both lecture and laboratory settings, with frequent demonstrations at the lecture
demonstration table with the use of threedimensional molecular models for illustration. I often selected
demonstrations that challenged their conventional thinking, such as showing that when a liquid boils, its
temperature drops, and when it freezes, its temperature rises. When a student asked me if it was true
that the foam in beer had more alcohol content than the liquid, we found out that it didn’t by titrating
both for alcohol content in the lab.

My lectures included many questions that I asked of the students in general and sometimes directed to
specific students. Attached to my belt was my trusted slide rule, which I used during lecture sessions to
make necessary calculations, accurate to three significant figures. Students, of course followed along
with their own slide rules. We used a keypunch machine and the college’s mainframe computer to run
Fortran programs for the data analysis for some of our lab experiments. By the 1970s, the slide rule was
replaced by the first Hewlett Packard (HP) 35 hand-held calculator. Before long, calculators were
inexpensive enough for students to have their own.

In the early 1970s, the college purchased a portable Sony video tape recorder.

Of course, it was bulky by today’s standards, occupying a large suitcase when not in use. My first project
was to prepare a video on how to use the balance appropriately to measure mass. This had previously
been a time-consuming activity, requiring several demonstrations to small groups on the first day of lab.
The new technology made the process more efficient and more effective.

Throughout most of my time as a chemistry teacher, the technology of teaching and learning was slow
to change. The chalkboard, the demonstration table, and the hand-held calculator were the tools at my
disposal. Lecture, demonstrations, laboratory experiments, and sometimes fieldwork were my main
methods of teaching.

Extra study sessions helped the students to learn the material and to prepare for examinations. The
keypunch and mainframe computer were eventually replaced by the first Apple microcomputer to
process experimental data. Students took notes in class and wrote lab reports after each experiment.
Quizzes and examinationsalong with lab reports were the measures of student learning and instructor
feedback— and the basis for the grades that were issued at the end of the term.

Today, I teach doctoral classes in community college leadership instead of freshman and sophomore
chemistry after several years away from the classroom. It is a different world, in part because the
students are experienced community college faculty members and administrators instead of freshmen
and sophomore chemistry students, in part because the subject matter is so different, but also because
of dramatic advances in technology. I am sure that the teaching of chemistry has changed dramatically
from the 1960s and 70s, and I would probably be using more engaging teaching techniques and more
advanced technology were I still teaching that subject today.

In my doctoral classes today, I am able to beam well-known education leaders and policy makers into
my classroom using video conferencing technology. After introductions, I usually ask the virtual guests
both predetermined and spontaneous interview questions and then give the students a chance to ask
questions. It is almost like being in the same room with people whom the students would otherwise
likely not have a chance to meet. Students have their laptop computers, electronic tablets, and cell
phones on during class, taking notes and searching the Internet for the latest information on topics that
come up in our classroom discussions.

Between face-to-face class meetings, the students and I engage in lively online discussions on topics that
are assigned or in response to questions that I ask, usually about an issue addressed in a recent higher
education newspaper. I post information on the course learning management system or engage in email
exchanges with the students daily for the duration of our course.

Every student in the class is engaged in the discussions and exchanges with me and with colleague
students. This new environment is a significant departure from the lecture hall of the 1960s and 70s,
where rigid seating made it almost impossible for students to interact with one another and where
students in the back row may never have asked a question or been called upon. Today, between face-to-
face meetings, we sometimes schedule a virtual class session, often involving a guest presenter, whom
the students can see and with whom they can interact. These sessions can be recorded and links to the
sessions can be placed on the course learning management system.

Students also listen to prerecorded interviews with policy makers and education authorities by clicking
on links in the course learning management system. Rather than a textbook, students access articles and
books through electronic links or through the university virtual library. Students turn their assigned
reports in electronically to the learning management system, which automatically checks for original
work. I grade the written work, typing comments and tracking suggested changes, using the word
processing review tools. I can even record oral comments on individual student work. Students view
their grades and see or listen to my comments and suggested edits through their access to the learning
management system.

Another noticeable difference is the lasting connections made by my teaching. My former doctoral
students frequently contact me for advice about other coursework or a dissertation topic. Even after the
students complete their doctorates, they often email or call to ask for advice about a work-related issue
or to seek career advice. They remain connected to one another as well. I often get copied on group
email messages. The cohort learning environment that is enabled by technology helps the students to
stay connected and to form a lasting professional network.

Today’s educational technology has almost forced a greater engagement between faculty and students
and among students. It is helping faculty to focus more on the learning environment for their students.
But it has also changed the way colleges do business. In the 1980s, when I was at Palomar College, we
moved away from in-person registration lines to phone-in registration—and then, in the 1990s, to online
registration. Today, students can order books online and may never visit the college bookstore. The card
catalog is long gone from the library, and today’s research tools are more targeted and more efficient.
Today’s college library is often home to computer labs and tutor centers. Tutoring and counseling
sessions can now be conducted remotely.

Although I no longer lecture in my classes, I am frequently asked to speak or to consult in situations in

which a presentation is most appropriate. My presentations today make use of PowerPoint slides
instead of 35 mm slides or overhead transparencies, and I often use Internet connections to go to a
website or to show a video clip to illustrate a point. Of course, presentations using newer technology
can be as boring as any dull lecture if not prepared in ways to engage the audience, but they have the
advantage of allowing the presenter to put together a customized presentation efficiently, and the
presentation can be transported on something as small as a USB drive.

College leaders are also making use of technology to plan and to make data-informed decisions. They
can evaluate the effect of new strategies to improve college completion rates and to improve efficiency.
Analytics can now help colleges identify students who are most at-risk of failure or dropping out,
enabling college personnel to intervene and provide needed individualized support. Early alerts can be
sent automatically to students who need assistance. Customized electronic dashboards showing up-to-
date information are now available to college faculty, staff, administrators, and trustees, enabling them
to monitor progress toward college goals. Transcripts of coursework can now be forwarded
electronically at the request of students. Systems that monitor energy and water usage enable college
leaders to change behaviors and decrease expenses in order to reallocate funds to support more directly
the mission of student learning. Class scheduling software makes a formerly complex and tedious task
more accurate and efficient.

I am not an expert on educational technology, and other writers are likely to be much more
knowledgeable about the topic. I am an educator who has been privileged to be a teacher,
administrator, and observer during a time when new technologies have made it possible to increase
student engagement and to make college processes more efficient and effective. With help, I have been
able to learn how to navigate three different learning management systems.
However, there are some cautions to consider about reliance on complex technology. Community
colleges were early adopters of online education and, today, online courses are usually the first to fill
during class registration. However, studies have shown that student attrition is higher in online courses
than in in-person or hybrid courses. Unless an online class is highly structured with built-in tools for
engagement and evaluation, students may not have the self-discipline that it takes to complete the
course. For that reason, entirely online courses may not be the best method of promoting student
learning in developmental courses.

Massive open online courses (MOOCs), once thought to transform higher education, proved to have
limited potential to replace other methods of instruction. Because of the high student to faculty ratio,
engagement between faculty and students is limited, and the attrition rates are shockingly high. MOOCs
may have potential uses for those who are not interested in a degree or credential or as supplementary
material for a more traditional college course.

We also need to be cautious of overreliance on technology. Not too long ago, I was stuck in an airport
for several hours because a malfunction in the airline reservation system caused all of its planes to be
grounded. In an earlier time, planes were able to fly without computers, yet on that day a computer
problem paralyzed the company. Not long ago, a disgruntled employee caused problems for thousands
of travelers by destroying part of the air traffic control system near Chicago. Hackers have been able to
break into sites that we thought were secure to steal information or to cause destruction. We need to
be sure that our college systems have both appropriate security and redundancy to serve as a backup in
case information is lost.

Higher education institutions have been historically slow to change. Some compare the rate of change in
higher education to that of the Catholic Church. We probably all still know of some faculty members and
administrators who resist the use of technology. Paul Elsner, the former chancellor of the Maricopa
Community College District in Arizona, tells a story of a faculty member at one of the Maricopa colleges
who used his office computer only as an expensive doorstop. But I have also seen some significant
changes in educational methodology during my career, and newly hired faculty have grown up in a
technological world in which they have generally used social media and other electronic methods of
communication, entertainment, and learning most of their lives. They and their students will drive the
use of technology to improve teaching and learning in our colleges. Pressure to improve student success
rates will force institutions and systems to use technology to support students and to make the kinds of
data-informed decisions that lead to improved outcomes.

George R. Boggs is president and CEO emeritus of the American Association of Community Colleges and
superintendent/president emeritus of Palomar College in California. He is a clinical professor in
Community College Leadership for the Roueche Graduate Center of National American University and an
adjunct professor of Community College Leadership for San Diego State University.

When students are using technology as a tool or a support for communicating with others, they are in
an active role rather than the passive role of recipient of information transmitted by a teacher,
textbook, or broadcast. The student is actively making choices about how to generate, obtain,
manipulate, or display information. Technology use allows many more students to be actively thinking
about information, making choices, and executing skills than is typical in teacher-led lessons. Moreover,
when technology is used as a tool to support students in performing authentic tasks, the students are in
the position of defining their goals, making design decisions, and evaluating their progress.
The teacher's role changes as well. The teacher is no longer the center of attention as the dispenser of
information, but rather plays the role of facilitator, setting project goals and providing guidelines and
resources, moving from student to student or group to group, providing suggestions and support for
student activity. As students work on their technology-supported products, the teacher rotates through
the room, looking over shoulders, asking about the reasons for various design choices, and suggesting
resources that might be used. (See example of teacher as coach.)

Project-based work (such as the City Building Project and the Student-Run Manufacturing Company) and
cooperative learning approaches prompt this change in roles, whether technology is used or not.
However, tool uses of technology are highly compatible with this new teacher role, since they stimulate
so much active mental work on the part of students. Moreover, when the venue for work is technology,
the teacher often finds him or herself joined by many peer coaches--students who are technology savvy
and eager to share their knowledge with others.

Increased Motivation and Self Esteem

The most common--and in fact, nearly universal--teacher-reported effect on students was an increase in
motivation. Teachers and students are sometimes surprised at the level of technology-based
accomplishment displayed by students who have shown much less initiative or facility with more
conventional academic tasks:

The kids that don't necessarily star can become the stars. [with technology]. My favorite is this boy . . .
who had major problems at home. He figured out a way to make music by getting the computer to play
certain letters by certain powers and it changed the musical tone of the note and he actually wrote a
piece. He stayed in every recess. . . . When I asked him what he was working on, he wouldn't tell me.
Then he asked if he could put his HyperCard stack on my computer because it was hooked up to
speakers. I said "sure" and at recess. . . he put it on my computer and played his music and literally
stopped the room. And for months he had kids begging him at recess, every recess, to teach them how to
make music. And for that particular kid it was the world because he really was not successful
academically and was having lots of problems. . . . This really changed him for that school year. -
Elementary school teacher

Teachers talked about motivation from a number of different perspectives. Some mentioned motivation
with respect to working in a specific subject area, for example, a greater willingness to write or to work
on computational skills. Others spoke in terms of more general motivational effects--student satisfaction
with the immediate feedback provided by the computer and the sense of accomplishment and power
gained in working with technology:

Kids like the immediate results. It's not a result that you can get anywhere else except on the computer. .
. . For them it really is a big deal. Much more so than I ever though it was going to be. --Elementary
school teacher

Technology is the ultimate carrot for students. It's something they want to master. Learning to use it
enhances their self-esteem and makes them excited about coming to school. --Fifth grade teacher
The computer has been an empowering tool to the students. They have a voice and it's not in any way
secondary to anybody else's voice. It's an equal voice. So that's incredibly positive. Motivation to use
technology is very high. --Elementary school teacher

In many of these classes, students choose to work on their technology-based projects during recess or
lunch periods. Teachers also frequently cite technology's motivational advantages in providing a venue
in which a wider range of students can excel. Compared to conventional classrooms with their stress on
verbal knowledge and multiple-choice test performance, technology provides a very different set of
challenges and different ways in which students can demonstrate what they understand (e.g., by
programming a simulation to demonstrate a concept rather than trying to explain it verbally).

A related technology effect stressed by many teachers was enhancement of student self esteem. Both
the increased competence they feel after mastering technology-based tasks and their awareness of the
value placed upon technology within our culture, led to increases in students' (and often teachers')
sense of self worth.

I see more confidence in the kids here. . . . I think it's not just computers, it's a multitude of things, but
they can do things on the computers that most of their parents can't do and that's very empowering and
exciting for them. It's "I can sit down and make this machine pretty much do what I want to," and there's
something about that that gives them an extra little boost of, "Wow, I'm a pretty special person." --
Elementary school teacher

Students clearly take pride in being able to use the same computer-based tools employed by
professionals. As one teacher expressed it, "Students gain a sense of empowerment from learning to
control the computer and to use it in ways they associate with the real world." Technology is valued
within our culture. It is something that costs money and that bestows the power to add value. By giving
students technology tools, we are implicitly giving weight to their school activities. Students are very
sensitive to this message that they, and their work, are important.

Technical Skills

Students, even at the elementary school level, are able to acquire an impressive level of skill with a
broad range of computer software (see examples). Although the specific software tools in use will likely
change before these students enter the world of work, the students acquire a basic understanding of
how various classes of computer tools behave and a confidence about being able to learn to use new
tools that will support their learning of new software applications.

Accomplishment of More Complex Tasks

Teachers for the observed classes and activities at the case study sites were nearly unanimous also in
reporting that students were able to handle more complex assignments and do more with higher-order
skills (see examples) because of the supports and capabilities provided by technology.

More Collaboration with Peers

Another effect of technology cited by a great majority of teachers is an increased inclination on the part
of students to work cooperatively and to provide peer tutoring. While many of the classrooms we
observed assigned technology-based projects to small groups of students, as discussed above, there was
also considerable tutoring going on around the use of technology itself. Collaboration is fostered for
obvious reasons when students are assigned to work in pairs or small groups for work at a limited
number of computers. But even when each student has a computer, teachers note an increased
frequency of students helping each other. Technology-based tasks involve many subtasks (e.g., creating
a button for a HyperCard stacks or making columns with word processing software), leading to situations
where students need help and find their neighbor a convenient source of assistance. Students who have
mastered specific computer skills generally derive pride and enjoyment from helping others.

In addition, the public display and greater legibility of student work creates an invitation to comment.
Students often look over each others' shoulders, commenting on each others' work, offering assistance,
and discussing what they are doing.

I've also seen kids helping each other a lot at the computer. The ones that pick it up faster, they love
teaching it to someone that doesn't know it yet. --Fifth-grade teacher

The ones who have used it from the beginning have become peer coaches. --Fifth-grade teacher

Students' ability to collaborate on substantive content can be further enhanced through the use of
software applications specifically designed for this purpose. Students in several classes at one of our
case study sites used a research package called CSILE (Computer Supported Intentional Learning
Environment), for building a communal database and exchanging comments about each others' ideas.

One of our teacher informants made the point that the technology invites peer coaching and that once
established, this habit carries over into other classroom activities:

It's a much more facilitating atmosphere because the kids help each other so much on the computer. It
changes the style and the tone of the classroom a lot. --Elementary school teacher

Though the use of technology often promoted collaboration and cooperation among students at these
case study sites, there were still concerns about appropriate student conduct. Many schools
implement acceptable use policies, especially if they offer students access to the Internet. (See examples
of Sharenet's formal technology use agreement or other acceptable use policies.)

Increased Use of Outside Resources

Teachers from 10 out of 17 classrooms observed at length cited increased use of outside resources as a
benefit of using technology. This effect was most obvious in classrooms that had incorporated
telecommunications activities (see examples), but other classes used technologies such as satellite
broadcasts, telefacsimiles, and the telephone to help bring in outside resources.

Improved Design Skills/Attention to Audience

Experiences in developing the kinds of rich, multimedia products that can be produced with technology,
particularly when the design is done collaboratively so that students experience their peers' reactions to
their presentations, appear to support a greater awareness of audience needs and perspectives.
Multiple media give students choices about how best to convey a given idea (e.g., through text, video,
animation). In part because they have the capability to produce more professional-looking products and
the tools to manipulate the way information is presented, students in many technology-using classes are
reportedly spending more time on design and audience presentation issues.

They also do more stylistic things in terms of how the paper looks, and if there is something they want to
emphasize, they'll change the font . . . they're looking at the words they're writing in a different way.
They're not just thinking about writing a sentence, they're doing that, but they are also thinking about,
"This is a really important word" or "This is something I want to stand out." And they're thinking in
another completely different way about their audience. --Elementary school teacher

While most teachers were positive about the design consciousness that technology fosters, a potential
downside was also noted by a few teachers. It is possible for students to get so caught up in issues such
as type font or audio clips that they pay less attention to the substantive content of their product. We
observed one computer lab within which several students with a research paper assignment spent the
entire period coloring and editing the computer graphics for the covers of their as-yet-unwritten
reports, pixel by pixel. Teachers are developing strategies to make sure that students do not get
distracted by some of the more enticing but less substantive features of technology, for example, by
limiting the number of fonts and font sizes available to their students.