Journal of Advanced Nursing, 1979, 4,181-192

The audio-visual revoiution: do we reaiiy need it? Ian Townsend Educational Media Adviser, National Health Service Learning Resources Unit, Sheffield Accepted for publication 30 August 1978

TOWNSEND I. {1979) Journal of Advanced Nursing, 1979, 4, 181-192

The audio-visual revolution: do we reaUy need it? In the United Kingdom, the audio-visual revolution has steadily gained converts in the nursing profession. Nurse tutor courses now contain information on the techniques of educational technology and schools of nursing increasingly own (or wish to own) many of the sophisticated electronic aids to teaching that abound. This is taking place at a time of hitherto inexperienced crisis and change. Funds have been or are being made available to buy audio-visual equipment. But its purchase and use reHes on satisfying personal whim, prejudice or educational fashion, not on considerations of educational efficiency. In the rush of enthusiasm, the overwhelmed teacher (everywhere; the phenomenon is not confined to nursing) forgets to ask the searching, critical questions: 'Why should we use this aid?', 'How effective is it?', 'And, at what?'. Influential writers in this profession have repeatedly called for a more responsible attitude towards published research work of other fields. In an attempt to discover what is known about the answers to this group of questions, an eclectic look at media research is taken and the widespread dissatisfaction existing amongst international educational technologists is noted. The paper isolates out of the literature several causative factors responsible for the present state of affairs. Findings from the field of educational television are cited as representative of an aid which has had a considerable amount of time and research directed at it. The concluding part of the paper shows the decisions to be taken in using or not using educational media as being more complicated than might at first appear.

INTRODUCTION In common with other branches, nurse education has within it a small hand of enthusiasts dedicated to the use of audio-visual (AV) aids. Like their sisters elsewhere they are convinced that the possession and use of AV media stimulates and enhances both teaching and learning. 0309-2402/79/0300-0181 $02.00

© 1979 Blackwell Scientific Publications 181


I. Townsend

Wliile the nursing profession ambled along down well-worn curricular paths, stopping at familiar training places, their presence did little damage. In fact it was probably beneficial in stimulating interest on a small, locally determined basis. But the relatively sudden current spurt of curriculum re-examination and restructuring taking place on a national level olfers them dangerous scope to explore events and influence outcomes predeterminantly (Townsend 1978a). This spurt marks a point unique in nursing education. It is a point which occurs but rarely in the evolution of a field of activity, a point at which the claimed success and wellstanding of teaching strategies can be carefully examined at a distance from the pressures of tradition (UNESCO 1971). But it is a nebulous, dynamic point, never standing still. The danger lies in attention not being paid now to what research can tell us; in the moment being missed in the rush of enthusiasm. Commitment to educational media is made everywhere in the absence of clear-cut and publicly debated research results (Clarke 1976, Hawkridge 1973, Townsend 1976a). Such commitment effectively binds teacher, taught and process into stereotypes which are pale reflections of what they could be. Perhaps this commitment can be enlightened by a broad look at the products of almost 70 years of media research?

MEDIA RESEARCH Even the briefest of glances at the evidence is depressing and exciting. Exciting because the whole field 15 dynamic and developing; depressing because, with few exceptions, there are no clear-cut results. What there seem to be are lots of signposts, many of which bear no name, some of which are pointing in the wrong directions. In the few cases of genuinely legible labels, there is little to show they have ever been read, let alone applied. To a very large extent this paucity of hardline usable evidence seems to be tied up with the history of educational media (Saettler 1969, 1978, Hawkridge 1976); the ways in which research design has been approached (Stowe 1973, De Vaney Becker 1977, Torkelson 1977, Stewart 1978) and an overemphasis on one part of the system at the expense of the whole (Holroyde 1971, Hoban 1977, Wilkes 1978). There is a very real danger in individuals and systems being seduced by the promises of an as yet unproven technology; in seeing the advantages of educational media as pit-props, adding on to or supporting crumbling curricula; in being used to point up the brickwork of the curriculum rather than rebuild it. The claimed benefits of a systematic (educational technology based) approach to curriculum renewal are easily missed beneath the day-to-day practicalities of choosing and using educational media, because, like Everest, 'they are there'. In all spheres of education over the past 50 years electronic aids to teaching have gained a steady foothold. Organizations, commercial and philanthropic, have flowered or foundered in attempting to service them. Educational empires

The audio-visual revolution


have been erected to their use. Their use has been taken for granted: but is their use justified? Two 1971 publications (Silbermann, UNESCO), reviewing some of the prominent educational reforms of the previous 20 years concluded that their use certainly was not justified in terms of impact on classroom practice. Other publications have questioned the basic tacit assumption that media do improve learning (Anderson 1968, Dieuzide 1971, and especially Olson 1974). These serve to put into perspective the rapid development of media-based learning systems which has taken place since that time. What is required is for us enthusiasts to take a long, hard look at the theoretical underpinnings of our beliefs about educational media; so that we can function more knowledgeably, if not more efficiently (Gibb 1976).

Wasted effort? Media research has a long and chequered pedigree, one which has been amply reviewed in Popham (1969), Allen (1971), Campeau (1972) and Torkelson & Driscoll (1968). Early (pre 1950) studies concentrated on unsystematic Method A v. Method B comparisons and tried to establish their validity in the absence of any broad philosophic or theoretic framework. This type of methodological approach has received severe criticism (Kopstein & Seidel 1967). The early studies are important in that certain of them (especially those carried out by the American Military in the late 40s and early 50s) constitute sole systematic efforts (Allen 1971). The reviews of Allen (1971) and Campeau (1972), both of them major and comprehensive, neither of them alone in their criticisms, raise the serious problem of dissemination. Both remark on the absence of practical use to which the findings have been put in the classroom. Media research is, in this view, of limited value in ascribing or assigning rationale for using its products in nurse education. But it is not all a wasted effort for the limitations of past work can be salvaged and born in mind in the design of future studies. Time and again 'no significant difference' (NSD) tolls the knell on a piece of work. Rodwell (1976) highlights this and additionally points out that 'more confusingly, some studies show one medium is preferable, others another'. An authority in the field (Jamison 1974) cites the NSD phenomenon as a major reason for the widespread lack of implementation of educational media. As this paper shows later, NSD findings are commonplace, and the stress laid on researchers' inability to overcome this hurdle has effectively prevented them from concentrating on other, more fruitful, questions. Jamison (1974) and Briggs et al. (1967) also suggest that NSD findings are not so much a criticism cf the result of media research, but more an artefact of its design. However, it does seem that the early crude research has been necessary if only to point out its own shortcomings. It has been research with media, concentrating


I- Townsend

on physical characteristics. Current research tends to be research on media, concentrating on the 'relevant attributes of media which interact with individual differences to effect learning' (Clark 1975). Two writers see benefit in the NSD arena. Oettinger (1972) points out that we tend to assume that 'NSD' means 'worse', and it doesn't: and Hubbard (1976) that it 'ends, at least until we know a great deal more than we know at present, the hunt for a "best" method for teaching, particularly content; what is best for one student at one time may not be best for another student, or even for the same student at a different time'.

Bias Carnoy & Levin (1975), in a seminal position paper postulated two types of bias as being present in research reports and reviews of research. The benefit of doubt bias occurs when aspects of research which tend to favour media over tradition are accepted (very often unconsciously), even on the basis of deficient data. The second type of bias is even more serious. The authors maintain that the assumptions we make about the value of educational media are extremely limited because they are usually made without reference to the broad social framework in which education operates, and effectively serve to strangle the growth of real innovation (CARE 1974, 1977). Heath (1978) touches on this within the nursing process context; Townsend (1978b) has identified it within the nurse education context. The bulk of media research has been of little practical help to the teacher. It is ignored, under utilized or methodologically questionable. This is not to deny or decry the tremendously important part that its wider aspects are playing in nursing's curriculum development processes. With the exception of the last citation, the criticisms have been those of one very small, but important, branch of educational technology, not criticisms of the whole. The expectation is that media will magically solve our educational problems, but we are ignorant of the effective techniques and criteria for its use (Baggaley 1973, Townsend 1978a). The flood of low level research findings have been necessary to direct attention to more appropriate studies. They have contributed to considerable consciousness-raising and the need for clarification in the design of teaching-learning activities (Edling 1968, Dieuzide 1971). Present day usage seems to be in spite of rather than because of published evidence, which in any case only seems able to provide the broadest of generalizations. With this in mind, ought monies to be continued to be invested in sophisticated but superficial equipments and systems? The literature suggests that the current utilization model (where an accurate diagnosis of learning illness, and the selective identification of audio-visual remedy leads to rapid recovery of the patient) is just not at all appropriate.

The audio-visual revolution


On the contrary, what is happening is an attempt to derive a theoretic framework (MacDonald-Ross 1972, Olson 1975, Salomon 1976) in the light of the pathology of the past. Schools of nursing globally invest large sums of money on electronic aids. These are irrationally chosen in the absence of a descriptive theoretic framework. Considerable concern is evident internationally with the state of the media market. New research methodologies and techniques are developing to aid users. Nurse educators should be aware of this parlous state, especially at what is considered by the author to be a unique and vital period in the profession's development.

TELEVISION A N D N U R S I N G Most papers dealing specifically with television in nursing have originated abroad. Without exception they are superficial, dealing only with its mechanics and applications. What is missing is any attempt to fit the medium into the structure of nurse education. Basically, the papers are descriptive. Anderson (1964, 1970), Fish (1971) and Miles (1975) are all worth reading for this point of view, as is Griffin et al. (1964), one of the few descriptions of an approach in the clinical field. The applications described rely almost entirely on what television can do because of its physical nature and they are applications of a genus of effects specific to education as a whole. Few authors, including those mentioned in the bibliography (Townsend 1978c), are aware of supportive research and in most cases are sadly outdated. Carpenter & Kroth (1976), in a paper dealing with interactive use of television, do show considerable awareness: but this is just one paper amongst many. The approach taken by most writers is one of benign optimism. This is an approach v^^hich must be questioned.

Research evidence There are few accounts of research involvement in a medical context. Ramsey (1967) surveyed television use in 88 medical schools and concluded that the impression 'of widespread and various use vv^as not supported by the data. Most users were experimental and isolated in nature.' Quiring (1972) reports a project dealing with the attainment of psychomotor skills by television, and identifies factors outside of the television experience as being responsible for enhanced learning. And from the field of general education (BaHn 1968, Torkelson & Driscoll 1968, Jamison et al. 1974, Wells 1976) the great w^eight of evidence reveals 'No Significant Difference'. Chu & Schramm (1967) represent the major work in this field, updated by several review papers. A general conclusion is that the success of television is due to the care that goes into using it rather than any particular inherent quality it possesses.


I. Townsend

Jamison et al. (1974) updating Chu & Schramm (1967) and from a survey of 421 comparative studies, concludes that 'students at all levels learn well from instructional television . . . (its) effectiveness cuts across virtually every subject matter'. Perrin (1976) considers the interesting point that as a viable alternative to traditional teaching methods, television is 'equally effective when conducted in alternative learning environments'. Generalizing, the advantages of being involved with TV seem to be those of AV media in general (Townsend 1978a). That is, it focuses attention on problems in the teaching-learning continuum in a unique way; it stimulates group planning and working; it creates and maintains an atmosphere which supports innovation; and it alters the student's role. Summaries suggest that students receive educational television (etv) favourably, that their attitude is even more favourable after they have experienced it. The attitude is more marked to etv in general than towards any particular televised course: if given the choice between a televised course and a conventional one, students do not prefer the former. When faced with the choice between a televised and a large-lecture course they modify their attitude in favour of the televised one and feel that they learn at least as much from it as from the conventional one. The addition of colour to the presentation does not affect learning of central material. Work has been carried out which suggests that colour is useful in raising student judgement of the material (Katzman & Nyenhuis 1972). Until a lot more is known about its role in the educational process, television must be regarded as an educational prima donna. And like prima donnas everywhere she demands constant attention and much money to keep going. Television is the audio-visual aid which has attracted probably the widest body of research to it. Despite this volume, and the fairly clear statements about what television can and cannot do, nurse educators seem to be placing an unrealistic faith in its abihty to meet their demands. THE N A T U R E OF AV MEDIA The use of AV media in nursing is marred by misconception about the nature of the medium and its place in the learning process. There is a lot more to using electronic aids than simply switching them on. The simplest strategy? 'Start from what you've got' may at first sight seem appropriate. Certainly it is common advice and it is a very useful strategy. No doubt it has served many schools for many years: but served them well, or served them ill? It means, for instance, that users may rely on what is in the store cupboard, forgetting that it may not be an adequate way of meeting a particular learning need. Practically useful, the approach is theoretically vinsound, leading to 'we've got this, let's be sure we use it' medication where the user may well start off by

The audio-visual revolution


considering what it is the medium can do rather than what it is the learner actually needs. The strategy is based on the misconception that it is better to use what one has (however badly) than to leave it gathering dust on the shelf. It is based on the misconception that one can ask (and answer) the question 'which is the best AV medium to meet this particular learning outcome?' The question is improper. It implies that learning outcomes have been identified and specified in exact terms, that media characteristics can be matched to satisfy these outcomes, and that the teacher, the medium and the student are all three fmite static objects, whereas in fact they are not. A further difficulty is that what is available may be used badly, or not used at all. Not used at all because of doubts on how to use it, used badly because of the lack of practice (on the part of both the teacher and the taught), or because of ignorance of its physical requirements or inherent advantages and disadvantages. The impression to be got from reading the literature (especially the 'pulp' AV literature) and talking with enthusiasts (the picture of widespread, efficient, usage) is false. Even in schools with considerable investment, the time spent in using AV media is only a small proportion of the total; and its use clusters towards the more autocratic end of the dimensions considered in Figure i. Teacher Use

autocratic —»

Student Use


,,„„ tree

Increasing moves towards democracy Greater degree of systematization Increased initial and ongoing cost Increased production time support FtGtjRE I

intensive AV media in the learning system: some dimensions

Its use is more frequently unplanned and piecemeal rather than systematic, thought out and integral. The decision to use an AV medium has wider reaching effects, reported at length in the literature (Townsend, I978d,e) than are often imagined. PERCEPTIONS AND PRECONCEPTIONS Figure 2 provides a naive picture of the teaching-learning process from an AV planner's point of view. The process (a) is seen basically as an interaction between the teacher (T) and individual learner (L) during which an attempt is made to transfer information. Of course success depends on what perceptions and preconceptions both T and L bring to their interaction: a wide number of assumed, but in reality unknown


/. Townsend





T '*^=^zzZZ~SS^ ""—'


T- « ^ ^ ; ^ ^ - _

^ L

_ - _ * L- ^ ^


- (AVM) > L interaction is viewed by those within and without the immediate interaction as both individuals, groups and systems. For example, a T y (AVM) > L interaction, which enhances the learner's view of herself as moving towards her desired goal, is likely to succeed only if it takes place within a fmancial, professional and political system which supports and applauds this view. It is only likely to succeed if as many of these factors as possible are taken into account in the planning stage. And it is only likely to succeed where account is taken of what it is all for. In a nutshell, a vital, but all too often ignored factor in the interaction is 'attitude'.

The objective use of AV media Present use of media stems from a subjective bias. It starts from where the teacher is (or thinks she is) in respect to where the teacher thinks the learner is, and needs to be. It is 'end-directed' use rather than 'need-operated'. This usage could be the major reason for the lack of success of audio-visual media in nurse education. The educational process and the nursing process have been confused and confounded in an effort to produce a uniformly competent nurse (Dodds 1973, Bendall 1977, Heath 1978a). What is needed is a careful consideration of how these two processes impinge and interact on one another, and how each can be used to the other's advantage. Specification of AV media will depend on close and accurate statements of training objectives, expressed in terms which can be translated into how a specific medium and a specific learner can interact. CONCLUSION This paper underlines some serious problems to be considered in using AV media in nurse education. Current use is described as piecemeal, inefficient, naive. So, what hope is there for the future? What hope is there for the hardworked enthusiast who (like the author) sees little proven benefit from the products of the audio-visual revolution? Two avenues of potential are open: one based on published work, the other on intuition. The AV literature abounds with studies of selection processes. Heath (1978b) gives a useful bibliography describing the many elegant systems available for determining which aid might meet which need. Unfortunately, these are based mainly on observation during practice rather than on research. That they do work has been repeatedly demonstrated, how or why they work has not. However, they have in part stimulated a growing body of work, 'aptitude treatment interaction' (AVCR 1975) which is trying to learn how to match learner needs with media messages.


I. Townsend

The literature leads one to the conclusion that any use of AV media can have wide reaching effects. These can be viewed as disastrous and destructive or pleasant and productive. Intuitively, 'serendipitous seizures' are seen as occasions occurring during the use of an AV medium when the user (tutor or student) is suddenly brought up against basic issues. As the phrase is intended to suggest, such issues are unexpected by-products of using the medium, and can contribute, usefully or not, depending on the user's reactions. Such serendipitous seizures are seen as responsible for promoting healthy interand intrapersonal dialogue providing opportunity to question what it is that is actually being taught, as well as why, how, where and to whom. They serve to prevent intellectual stagnation by affecting our considerations of how we look at ourselves, the learning process and our students. They are seen as affecting both tutor and student motivation, positively or negatively, and as providing a base from which the system can expand. The Audio-Visual Revolution: do we KEALLY need it? The answer is a very firm yes. We need it, not so much for what its electronic components can do (for, as we have seen, the evidence is that they 'do' very little directly), but for what it has enabled us to do, unsuspectingly, and for what it may help us to do in the future. What we, as the enthusiasts, must do is to question very carefully our own criteria for advocating and supporting the audio-visual revolution. If necessary we must be prepared to defend our own conceptions of teaching and learning in the face of audio-visual advancement. Unless we are prepared to do this, our future development of the process of nursing education may be lost in the ensuing audio-visual austerity.

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American Institute for Research, Pittsburgh. CARE (1974) Safari: some interim papers. Centre for Advanced Research in Education. University of East Anglia.

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CARE (1977) Safari: theory into Practice. Papers 2. Centre for advanced Research in Education. University of East Anglia. CAMPEAU P.L. (1972) Selective review of the results of research on the use of AV media to teach adults. Council of Europe CCC/TE (72), 5. CARNEGIE COMMISSION ON HIGHER EDUCATION(1972) The Fourth Revolution: Instructional Technology

in Higher Education. McGraw-Hill, New York. CARNOY M . & LEVIN H . M . (1975) Evaluation of educational media: some issues. Instructional Science 4, Octoher, 385-406. CARPENTER K.F. & KROTH J.A. (1976) Effects of videotaped role playing on nurses therapeutic communication skills. Jownia/ of Continuing Education in Nursing 7, 2, 47-53. CHU G . C . & ScHRAMM "W. (1967) Learning From Television: What the Research Says. National Association of Educational Broadcasting, America. CLARK R.E. (1975) Constructing a taxonomy of media attributes for educational research purposes. Audio-Visual Communication Review 23, 2, 197-215. CLARKE M . (1976) An Account of the Outcome of Discussion on Research in Nursing. Paper read at the Septemher Conference, 1976, at Liverpool University. DiEuziDE H. (1971) Educational technology and the development of education. British Journal of Educational Technology 2, 3, 168-188. DoDDS A.P. (1973) Towards an Understanding of Nursing. PhD Thesis. Goldsmiths College, University of London. EDLING J.B. (1968) Educational objectives and educational media. Review ofEducational Research 37, 2, 177-194FISH E.J. (1971) Videotapes in schools of nursing. Nursing Mirror 132, 9, 18-20. GiBB F. (1976) Integrate staff training and educational technology. Times Higher Education Supplement, 236, 30 April. GRIFFIN, KISSINGER & PITMAN (1964) Clinical nursing instruction and C.C.T.V. Nursing Research 13, 3, 196-204. HAWKRIDGE D . G . (1973) Media Taxonomies and Media Selection. Mimeograph, Institute of Educational Technology. HAWKRIDGE D.G. (1976) Next year, Jerusalem! The rise of educational technology. British Journal of Educational Technology 7, i, 7-29. HEATH J. (1978a) A New Kind of Nurse, A New Approach to Learning: Issues for the Curriculum Builder. (In press.) HEATH J. (1978b) Curriculum Building Blocks: A Select Bibliography on Curriculum Processes in Nursing. Mimeograph, National Health Service Learning Resources Unit, Sheffield. HoBAN C.F. (1977) Educational technology and human values. Audio-Visual Communication Review 25, 3, 221-242. HoLROYDE D. (1971) Educational technology means men—or machines? British Journal of Educational Technology 2, 2, 137-142. HuBBARD G. (1976) Issues and pubUc policies in educational technology. British Journal of Educational Technology 7, 3, 51-58. JAMISOND., SUPPES P. & WELLS S. (1974) Effectiveness of alternative instructional media: a survey. Review of Educational Research 44, i, 1-69. KATZMAN N . & NYENHUIS J. (1972) Colour versus hlack and white: effects on learning, opinion and attention. Audio-Visual Communication Review 20, i, 16-28. KOPSTEIN F.F. & SEIDEL R.J. (1967) Comments on Schurdaks: an approach to the use of computers in the instructional process. American Educational Research Journal 4, 413-416. MACDONALD-ROSS M . (1972) The Problem of Representing Knowledge. Structural Learning Conference. Philadelphia, U.S.A. MILES I . M . (1975) A multimedia approach to education. South American Nursing Journal 42, 8, 14-15. OETTINGER (1972) In Carnegie Commission on Higher Education. McGraw-Hill.


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OLSON D . R . (1974) Introduction to Media and Symbols: the forms of expression, communication and education. Yearbook of the National Society. PERRIN D . G . (1976) Synopsis of television in education. Educational Technology May, 7-9. PoPHAM W.G. (1969) Curriculum materials. Review of Educational Research 39, 3, 319-338. QumiNG J. (1972) The audiotutorial approach. Nursing Research 21, 4, 332-336. RAMSEY J . W . (1967) Television in Medical Teaching and Research. ERIC Microfiche. ED 003 147. RoDWELL S. (1976) Comparative media research. Visual Education ]une, 19-21. SAETTLER p. (1969) Instructional technology: some concerns and desiderata. Audio-Visual Communication Review 17, 4, 357-367. SAETTLER P. (1978) The roots of educational technology. Programmed Learning and Educational Technology 15, i, 7-i5SALOMON G. (1976) A cognitive approach to media. Educational Technology May, 25-28. SiLBERMANN C. (1971) Crisis in the Classroom. Random House, New York. STEWART A. (1978) Appropriate Educational Technology. Paper given at APLET/ETIC Conference, 1978. (In press.) STOWE R . A . (1973) Research and the systems approach as methodologies for education. AudioVisual Communication Review 21, 2, 165-175. ToRKELSON G.M. & DRISCOLL J . P . (1968) Utilization and management of learning resources. Review of Educational Research 38, 2, 129-159. ToRKELSON G.M. (1977) AVCR—one quarter century: evolution of theory and research. AudioVisual Communication Review 25, 4, 317-357. TOWNSEND I. (1976a) The Face and Future of Media Research in Nurse Education. Paper presented at the September Conference, 1976, at Liverpool University. TOWNSEND I. (1976b) The AV Revolution: Do We Really Need It? Part 1: General Considerations. Mimeograph, National Health Service Learning Resources Unit, Sheffield. TOWNSEND I. (1976c) Educational television explained. Nursing Mirror 143, i, 67-68. TOWNSEND I. (1978a) Are we using our educational resources efficiently? Nursing Times 74, 13, 549-550. TOWNSEND I. (1978b) Caring to Learn: The Evolution and Practice of Resource-based Learning in Nurse Education. M.A. Dissertation. University of York, Department of Education. TOWNSEND I. (1978c) Getting in the Picture: A Select, Annotated Bibliography for Television in Nursing. Mimeograph. National Health Service Learning Resources Unit, Sheffield. TOWNSEND L (i978d) A Comprehensive Bibliography on Innovation and Innovation Strategies. Mimeograph. National Health Service Learning Resources Unit, Sheffield. TOWNSEND L (i978e) Learning resources in nursing teaching. British Journal of Photography 125, 6163, 766-769. TOWNSEND I. (i978f) Complete Bibliography to The AV Revolution: do we really need it? National Health Service Learning Resources Unit, Sheffield. TOWNSEND I. & PARKER J. (1979) Tips to Television (in preparation). UNESCO (1971) The New Media: Memo to Educational Planners. UNESCO, Paris. DE VANEY BECKER A. (1977) Alternative methodologies for instructional media research. AudioVisual Communication Review 25, 2, 181-194. WELLS S. (1976) Evaluation criteria and the effectiveness of instructional technology in higher education. Higher Education 5, 253-275. WiLKES J. (1978) Theory in educational technology and curriculum. Programmed Learning and Educational Technology 15, i, 79-82.

The audio-visual revolution: do we really need it?

Journal of Advanced Nursing, 1979, 4,181-192 The audio-visual revoiution: do we reaiiy need it? Ian Townsend Educational Media Adviser, National Heal...
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