Open Organ Resources? Lessons from Sharing

You should read this post by Cable Green before proceeding below.

In 2001, MIT President Charles Vest’s annual report was titled Disturbing the Educational Universe: Universities in the Digital Age — Dinosaurs or Prometheans?. It is an absolutely seminal piece of writing in open education that is, sadly, underappreciated today. To most people, Prometheus is famous for stealing fire from the gods and gifting it to humanity, and this is the theme Dr. Vest follows in his address. However, when I hear the name Prometheus, my mind always turns immediately to his punishment. This is perhaps the only thing I remember from the weeks our high school English teacher spent dragging us yawning and snoring through Edith Hamilton’s Mythology. For his punishment, Prometheus was chained to a rock. And every day, day after day, an eagle came to tear out and eat his liver – which then regenerated overnight. How did the ancient Greeks know that livers regenerate? I always thought that was so cool… 

Several months ago, I received a phone call from a very close friend – Cable Green. He was calling to privately share the news that the PSC that had been slowly damaging his liver for years had a new roommate. He now also had liver cancer. Needless to say, this new development was dramatically accelerating his end of life timetable.

This was absolutely devastating news. Cable and I have been like brothers for over a decade. I can’t really describe the strength of the bond I feel we’ve developed as we’ve worked shoulder to shoulder in the trenches on anything and everything related to open education. Though I’ve given hundreds of talks over the years, a joint keynote we gave in Maryland stands out as one of my favorites.

After taking a beat to process the news, I uttered those embarrassingly feeble words that make you feel guilty just saying them – “Let me know if there’s any way I can help.” I suppose there’s some degree to which “it’s the thought that counts,” but the helplessness that I felt in that moment was so frustrating. He replied, “Well, actually, there’s this thing called living liver donation…”

The ancient Greeks knew a thing or two. Not only does the liver regenerate, but it regenerates really fast. Certainly not in a single day, but within a single month. And because this is true, the living liver donation procedure is possible. In the procedure, a surgical team removes all of the recipient’s liver, removes 2/3 of the donor’s liver, and puts the 2/3 liver from the donor into the recipient. Over the next few weeks, both the recipient and the donor regenerate their own full-sized liver. One becomes two!

Cable and I understood early on that there are a whole range of open education-related jokes to be made with regard to living liver donation. For example, is living liver donation the ultimate revise and remix activity? The recipient takes an existing resource (2/3 of the donor’s liver), incorporates it (into their body), and extends and enlarges it to truly “make it their own” (regenerating the missing 1/3). What could be a greater example of revise and remix? Then there are a range of jokes about “the 6th R” and whether this should be Regenerate or Regrow or something else. And of course, don’t we need a new Creative Commons Liver License? And, critically (sarcastically), should a person who remixes a CC-licensed liver into their body ever be allowed to participate in commercial activity again? I mean, that liver was very special to me, the donor… It was literally a part of me. Wouldn’t an NC restriction be reasonable? Etc. You get the idea. I think we’ve made most of the jokes that are possible at this point, but we’d love to hear new ones you come up with. These have been a real source of laughter and happy distraction to us.

I’ve learned a lot about organ donation over the last several months. Please take a few moments to learn more about organ donation. Being a living donor Raising your hand to volunteer is only the beginning of a very involved process. It is impossible to say whether the qualification process is more rigorous than the informed consent process, or vice versa. For me, both took place over a three day period earlier this year. The qualification process involved “lots” of bloodwork, a CT scan, an MRI, an ultrasound, health history surveys, a psych exam, and other things I’m certainly forgetting. You can be disqualified for being overweight, for choosing to donate for the wrong reasons, for not having a sufficient support network at home, for minor quirks in the anatomy of your own liver, and for a hundred other reasons. Gratefully, I qualified to be a donor.

The informed consent process was equally rigorous. In each interview and conversation, the donor gets some variation on the message, “There is no benefit to you as a donor – only risk. Do you understand? Can you explain back to me what the risks are and why there is no benefit to you?” The primary risk they want you to understand is the chance of dying as a result of donating. The rate of death attributable to donating is currently about 1 in 300. That would make choosing to donate my liver the most dangerous thing I had ever done, statistically speaking.

I’ve served on a university’s IRB before, and so I understand why the protocol is drumming into donors the idea that there’s no benefit for them in donating. The idea is that if I’m perfectly healthy and you put me on a table and start cutting me up, things can only get worse in terms of my physical health. But I’m more than my physical health. There definitely are benefits to doing what you can to give someone you love a chance to see their children grow up, graduate, get married, etc.

The most important thing I learned during the evaluation process was that the strictest rule governing a donor’s recovery – no lifting anything heavier than ten pounds for eight weeks – was actually stricter than I thought. The real rule is no lifting, pushing or pulling anything heavier than ten pounds for twelve weeks. The addition of pushing and pulling – including luggage – meant this would essentially create a three month travel blackout for me during recovery (unless someone traveled with me to wrangle bags). But more importantly, the change in the length of recovery meant I couldn’t fit in the procedure before my family’s cross country move from UT to WV this summer.

But things have a way of coming together. While additional donors were evaluated and disqualified, and Cable’s health continued to decline, my family managed to make our move earlier than we had originally anticipated. That created a narrow window in which we could do the procedure and I could complete my recovery a few weeks before the annual OpenEd conference. We decided to do it on June 28.

Perhaps the most dramatic part of this entire process is what is called the staging surgery. The day before the actual transplant is to happen, they open up the recipient and look around to make sure the cancer hasn’t gotten outside the liver. If the cancer has spread beyond the liver, then they close the recipient up and everyone goes home. Even though you’ve done all this planning, and found a donor, and the donor qualified, and you’ve all traveled to the Mayo Clinic in Rochester, and you’ve all made arrangements with work and family to take care of kids and support you through recovery, the whole thing can be canceled at the very last minute. Mentally, it feels like the whole world revolves around the staging surgery. In some ways I suppose it does.

Cable’s staging surgery on the 27th confirmed that the cancer was still confined within the liver and we got the green light for the transplant to proceed. So, on the morning of the 28th, we did it! There is still a lot of recovering to do, and many hurdles yet to overcome, but everything is moving in the right direction.

Cable and I have both learned a lot during this process and committed to each other that we would do some reflecting and blogging. Here is some of what I’ve learned being a living liver donor.

1. I am, apparently, a cry baby. I’ve broken down in tears more times than I can count in the last month. Thinking about Cable and what he must be feeling as he waited for the staging surgery. Finding out he was working on a “Cable has one year left to live” Google doc (of course) in case the staging surgery went poorly, and hearing a little of what was in it. Thinking about the small, but non-zero, chance that something might happen that left my family without a dad for a while. The few moments I spent pondering whether or not to write letters to my kids in case something went wrong. (I didn’t. I couldn’t.) Finding out that both procedures went as planned and that everyone’s recovery was off on the right foot. Seeing my wife for the first time after surgery. Seeing Cable up and alert after his surgery. My feelings have been incredibly tender for a while now, and I expect they will continue to

2. I had no concept of how tired a human being can get. I’ve run half-marathons. I’ve hiked 16 miles with 8,000 feet of elevation change in a day. But nothing prepared me for the utter, indescribable exhaustion associated with liver regeneration. The majority of the regeneration process happens very aggressively during the first week after surgery, with the remainder happening more slowly over the next three weeks. That first week I was so tired I couldn’t watch TV because of the effort required to follow what was happening in movies I had seen a dozen times before. I was so tired I couldn’t control my thoughts well enough to clear my mind so I could sleep. As the week ended and I got back on a computer for the first time, the effort of pressing the keys on the keyboard down far enough to register was exhausting. I’m sure there are medical and other conditions that can make a person even more tired than I have been, but I gained a whole new appreciation of what was possible here.

3. I didn’t know I was capable of feeling so much gratitude. I thought my heart would explode. I couldn’t contain it all, but it kept pouring into me somehow. It was like putting a huge array of solar panels in orbit close around the sun – a seemingly infinite flow of power without the possibility of interruption. Whatever capacity I had to feel gratitude before has been stretched and expanded out in ways I didn’t know were possible. And I have also been reminded just how nourishing to the soul it is to feel deep gratitude. I don’t know that there’s anything better for you than to stop, count your blessings, and just spend time feeling grateful.

4. Finally, priorities. When you spend time pondering life, and death, and family, and what comes next, it has a way of bringing your priorities into focus. Things that seemed like they were so important just weeks before suddenly don’t matter in the slightest. I expected the donation process to impact me deeply personally, which it has, but I’ve been surprised at how it is impacting me professionally, too. I am much more clearly focused on the change I’m trying to create in the world and the work I’m doing in support of that change. And I’m done allowing myself to be distracted by critics who think they know better than me what change I should be trying to create or how I should be going about it.

I’ll close this post with a video. It’s one of my all-time favorites, and at this point it should surprise no one to learn that I’m crying again after rewatching it just now. This is “For Good” from the musical Wicked. If you don’t know the song, take a minute to review the wonderful lyrics. This specific recording is from a Kristin Chenoweth concert. She has pulled Sarah Horn from the audience to sing Elpheba’s part of the duet. There’s so much about this video that is amazing – the song itself, Kristin’s reactions to what a great singer Sarah is, and seeing Sarah’s pure, unadulterated joy at having her moment on stage with a singer who is clearly one of her heroes. Everything about this video is magical.

I’ve been changed for good by many people in my life, including Cable. I’m grateful for his example of humility in reaching out to ask for help. Asking for help can be incredibly difficult, but Cable has managed it with grace. I’m grateful for everything he’s taught me these past months.

Please take a few minutes to reflect on who those people are in your own life that have changed you for good, and then take a few more minutes to enjoy feeling the gratitude this exercise will fill you with. You’ll be glad you did.

Attribution Confusion

Open Up Resources posted a short article yesterday expressing their frustration that people are violating the terms of the CC BY license under which they make their work available. From the post:

Our grant of the CC-BY License is conditioned upon the simple requirement that every copy shared with the public by a licensee includes on each physical page of any printed material, and every format page view of digital material, the attribution statement “Download for free at”

This attribution is a necessary part of our mission to ensure that everyone using the curriculum understands they can access the curriculum for free from its source, as it ensures all educators can access the curriculum regardless of their budget.

The post references their licensing page, which states:

Any reuse of the contents herein must provide attribution as follows:

    • If you redistribute this content in a print format, you must include the following attribution on every physical page: “Download for free at”
    • If you redistribute this content in a digital format, you must retain the following attribution in every digital format page view (including but not limited to EPUB, PDF, and HTML): “Download for free at”

OUR is clearly following OpenStax’s attribution example, as you can see at the bottom of any page in their online materals, like this one:

    • If you redistribute this textbook in a print format, then you must include on every physical page the following attribution:
      Download for free at
    • If you redistribute part of this textbook, then you must retain in every digital format page view (including but not limited to EPUB, PDF, and HTML) and on every physical printed page the following attribution:
      Download for free at

The problem with this approach to attribution is that the CC licenses don’t allow it. From the Creative Commons FAQ:

Can I insist on the exact placement of the attribution credit?

No. CC licenses allow for flexibility in the way credit is provided depending on the medium, means, and context in which a licensee is redistributing licensed material. For example, providing attribution to the creator when using licensed material in a blog post may be different than doing so in a video remix. This flexibility facilitates compliance by licensees and reduces uncertainty about different types of reuse—minimizing the risk that overly onerous and inflexible attribution requirements are simply disregarded.

You can’t require people to place an attribution statement at the bottom of each page – or require them to put it in any other specific location. Consequently, a reuser of CC BY-licensed content is not violating that attribution condition of the CC BY license if they choose to put their attribution statement somewhere else.

It’s too bad this misunderstanding blew up publicly before some basic questions could be asked and answered. Unfortunately, the open education community loves the “evil for-profit villain” storyline, and this post was apparently too good an opportunity to amplify that story on social media – whether it was true or not.

The most recent issue of IRRODL included an article titled Effectiveness of OER Use in First-Year Higher Education Students’ Mathematical Course Performance: A Case Study, by Juan I. Venegas-Muggli and Werner Westermann. Quoting from the article:

The main aims of this research were to examine the effect of OER use among higher education students and to analyze teacher and student views on OER use in order to better understand how these resources are used and valued. This was justified by the fact that there is a lack of empirical evidence to support expanding the use of OER. Moreover, recent societal demands to improve education quality in Chile have made this a relevant case study environment in which to examine the potentials of OER.

In relation to the first aim, the most important result is that students in face-to-face arithmetic/statistics courses using Khan Academy resources achieved significantly better exam grades than students who did not use any extra resources (p < 0.05) or those who used open textbooks as an extra resource (p < 0.01). The fact that the final exam was the same for everyone makes this a valid comparative measure of students’ performance.

As I read the article, I couldn’t help but reflect on a recent article in PLOS One by Phil Grimaldi and his colleagues at OpenStax, which challenged us to be more specific in our theorizing about why OER adoption might improve student learning. Despite popular rhetoric along the lines of “you can’t learn from materials you can’t afford,” their rather ingenious experiment showed that increasing access to learning materials by adopting OER instead of traditionally copyrighted resources (TCM) will almost never measurably improve learning. Learning will only improve measurably if you ALSO do something else.

So why did the Chilean math students who used Khan Academy do better than those who used either an open textbook or a traditionally copyrighted textbook? The underlying explanatory mechanism is extraordinarily simple. Students who have more opportunities to practice, receive feedback, reflect on that feedback, and practice again learn more than students who don’t have as many of those opportunities.  Whether you’re talking about conducting a literature review, playing a musical instrument, solving math problems, or literally anything else, practice with feedback is critical to learning.

Why, then, did the Chilean math students who used Khan Academy do better than those who used an open textbook? The students who used Khan Academy – specifically, students who used Khan Academy’s online homework system – had significantly more opportunities to practice, receive feedback, reflect, and practice again than students who used an open textbook. Unsurprisingly, the students with more opportunities to engage in online interactive practice did significantly better on the final exam. You have to read a bit between the lines of the article to see that students using Khan Academy weren’t just watching OER videos, but were also using the online interactive practice. I reached out to Werner and specifically verified this. He said teachers were also tracking student progress using Khan Academy’s analytics dashboards.

When Grimaldi et al. call on us to make the explanatory mechanisms underlying our research clearer (rather than just saying “OER was better”), this is the kind of clarification they’re calling for. If you didn’t know how Khan Academy worked before reading this article, you could easily have missed the role the online interactive practice system played in improving student learning and just thought “OER was better!”

This is not the first example, nor will it be the last example, of peer-reviewed research demonstrating that OER plus a system that provides opportunities to engage in online interactive practice results in better student learning than OER alone. And it shouldn’t surprise anyone that it’s true.

Research at CMU

A series of research papers from Carnegie Mellon going back almost 15 years has established this over and over again. In a 2016 article, Koedinger and colleagues wrote:

The “doer effect” is an association between the number of online interactive practice activities students do and their learning outcomes, that is not only statistically reliable but has much higher positive effects than other learning resources, such as watching videos or reading text… [We] provide generalizable evidence across four different courses involving over 12,500 students that the learning effect of doing [online interactive practice activities] is about six times greater than that of reading.

If you’re not familiar with educational research, 6x is a massive effect.

Other research from CMU explicitly connects the dots between (1) the significant impact of doing online interactive practice activities and (2) the somewhat common student practice of printing out their online learning materials.  Unsurprisingly, students who print out their online learning materials don’t do as many of the online interactive practice activities (“Volqs” in the path diagram below). Consequently, students who print do worse on both quizzes and final exams than their peers who work online.

Scheines, Leinhardt, Smith, Cho, (2005)

For more research along these lines from CMU, read just about anything by Ken Koedinger.

If you’ve heard that research says print is superior to online in terms of supporting student learning, take a closer look at that research. It generally compares reading print to reading online. But the CMU research, the Chilean research, and related research is comparing doing online interactive practice to reading online (in the CMU case) and reading offline (in the Chilean case). Regardless of the format of the materials students are reading, actively engaging in online interactive practice is more effective than simply reading. Again, this should not be a surprise to anyone.

Homework Systems

Unfortunately, there’s something akin to a conspiracy theory floating around the open education community about the systems that provide these opportunities to students. The statement of the conspiracy goes something like this. “Since publishers can’t really sell static content for exorbitant prices anymore, they’ve started selling homework systems. Far from adding value to student learning, these systems simply put a paywall in front of activities required to pass the course – like submitting homework and doing exams – making it impossible for students to look for cheaper alternatives. These systems are really just attempts by publishers to increase revenues by forcing students to buy access codes that can’t be resold.”

As with every good conspiracy theory, there’s some truth in that statement. But there are some huge falsehoods, as well.

First, homework systems aren’t a recent development. They’re not a response to the way OER caused the bottom to fall out of the textbook market. They’ve been around for a very long time, and they emerged in order to serve market demands that textbooks did not meet (and do not meet, and cannot meet). First, they provide students the opportunity to engage in online interactive practice and therefore have the potential to greatly increase student learning as described above. Second, they automate a large portion of the grading in a course, giving faculty back a large amount of time to do higher value activities, like meeting with students during office hours (or evaluating OER to adopt in place of their current traditionally copyrighted textbook).

Second, publishers can’t force students to do anything. Ever. Publishers don’t get to make adoption decisions, only faculty get to make adoption decisions. And for every homework system out there, there are dozens of static textbooks available that faculty are completely free to choose. However, faculty choose to require homework systems for their courses because they see benefits for both their students and themselves. So, if you’re looking to criticize someone for “making students pay to submit their homework,” 100% of your criticism should be directed at faculty – they’re the only ones who can require students to submit their homework in a particular way.

Now, do these systems need to be priced unconscionably high, as publishers have done historically? Absolutely not. While there absolutely are real, ongoing costs associated with hosting, maintaining, and securing online systems that hold student data, these costs are something like an order of magnitude lower than what publishers have traditionally charged. So if you want to criticize homework systems, but you don’t want to criticize faculty for choosing to adopt learning materials that actually improve student learning, criticize publishers for the way they price these systems. That’s the part that publishers control and, as we have seen with textbooks, it’s something publishers can and will change in response to market pressure.

And we have to talk a little more about costs.

From Open to Free

You may not have discerned it yet, but the open education movement is pulling apart. There’s a growing group of people and institutions whose primary commitment has shifted from open to free. You can see this primarily in the emergence of the “zero textbook costs / Z degree / Zed cred” movement, which generally has a different primary goal than the OER movement. Rather than focusing primarily on supporting the adoption of OER in order to both lower costs and facilitate OER-enabled pedagogy and other open educational practices, these programs focus on eliminating learning materials costs for students without regard for whether the materials used by faculty are open or merely free.

Sister causes, to be sure. Siblings, certainly. But not the same movements.

The interaction of this shift from open to free with what we know (and are continuing to confirm) about systems that enable students to participate in online interactive practice has a terrible unintended consequence. As an example, see this question and answer from a FAQ for California’s ZTC grant program:

12. Do fees for access to online materials disqualify a program? Do materials fees for lab classes and would it matter if they are actual materials fees or items purchased in a bookstore?

Fees for access to online instructional materials like MyMathLab are not allowed because components of these type programs [sic] include e-textbooks. Fees for materials in certain labs are allowed such as materials kits in cosmetology courses/labs.

Given what the research says about the significant learning impact online interactive practice systems can have, ZTC and similar policies can cross a line that OER advocates said we would never cross – sacrificing student learning for cost savings. Traditionally, one of the cornerstones of OER advocacy has been that faculty should never adopt OER in order to save students money if they thought that doing so would harm student learning. If they’re not careful, ZTC and related policies can abandon that foundational commitment, replacing it with something closer to “free at any cost.” And I don’t believe any of us want to be painted with this “free at any cost” (to student learning) brush.

The way ZTC / Z degree / Zed cred program policies can make it difficult for students and faculty to use and benefit from these systems seems to be a genuinely unintended consequence. Fortunately, like all policies, these policies aren’t laws of nature and can be changed after unintended negative consequences like this are identified.

A Concluding Thought

I know it makes people unhappy when I say it, but we’ve got to stop talking about “textbooks” if we want to improve student learning. Textbooks are universally understood by both faculty and students to be static compilations of words, tables, and images. Yes, the first conversation with a faculty member (or policymaker) can be easier when you say “textbook” rather than “learning materials” or “learning resources” or “courseware” or something else. But the price of the lubricant you use to grease the skids of that first conversation is a restriction of imagination that precludes the possibility of something interactive. Something that will improve student learning. The language of “textbooks” prevents faculty, administrators, policymakers, students, and others – including OER advocates – from seeing the adjacent possible. Maybe we needed to use the language of “textbooks” 20 years ago when we first started advocating for faculty to adopt open content. But, for the sake of student learning, it’s time to re-evaluate that decision.