Simulation has been a valuable educational tool for decades in health care. They have been particularly good for learning procedures and for specialties like surgery. There has been an increasing interest in simulations and there should be many interesting studies of learning from simulations in the next several years.
The Department of Veterans Affairs has recently opened a new Simulation Simulation Learning and Research Network (SimLearn). They've already produced a great 124 page resource: A Review of Simulation-Based Strategies for Healthcare, Education, and Training. It's a good place to start for anyone wanting an overview simulations in health care.
Sunday, November 28, 2010
Sunday, November 21, 2010
E-learning CME that changed practice behavior
One of the things I want to focus on in this blog are the kind of learning interventions that have been successful in changing practice behavior. Today I'm looking at a study published in JAMA in 2005.
In this study, what worked was 1) getting the information from an expert, 2) the opportunity to practice skills while working through cases, 3) the opportunity to spread the instruction out over a period of time, and 4) job aids that the physicians could use in their practices.
This was a well-designed study comparing a previously successful live CME event for physicians, with the same material presented in an e-learning format, and a control group that did not receive instruction. This was a good study, they measured learning immediately and at 12 weeks and more importantly, they measured actual physician behavior using chart reviews.
The live CME consisted of a lecture, followed by interactive case discussion with faculty, the participants received a number of job aids to help them when they got back to work.
The internet based instruction was designed to give people a similar experience - a recorded lecture, followed by cases that the physicians could work through. Both sets of learners had access to faculty if they wanted to ask questions. the internet CME group also had a live session, where they worked through cases with an expert. The major difference was that the internet-based instruction was done at the learners' convenience, and often over several different sessions.
Learning increased for both the live and the internet-based instruction group, both immediately after the instruction and at 12 weeks.
Practice behavior only changed significantly for the group that received instruction over the internet.
This is kind of a surprising result, why should the internet-based instruction be successful, while the live-training was not.
One reason might be that the internet-based group had the chance to complete the instruction in a single sitting. This fits with the instructional principle pf spaced practice - that is - spreading the practice over a period of time, which gives people a better chance to learn the material.
In this study, what worked was 1) getting the information from an expert, 2) the opportunity to practice skills while working through cases, 3) the opportunity to spread the instruction out over a period of time, and 4) job aids that the physicians could use in their practices.
This was a well-designed study comparing a previously successful live CME event for physicians, with the same material presented in an e-learning format, and a control group that did not receive instruction. This was a good study, they measured learning immediately and at 12 weeks and more importantly, they measured actual physician behavior using chart reviews.
The live CME consisted of a lecture, followed by interactive case discussion with faculty, the participants received a number of job aids to help them when they got back to work.
The internet based instruction was designed to give people a similar experience - a recorded lecture, followed by cases that the physicians could work through. Both sets of learners had access to faculty if they wanted to ask questions. the internet CME group also had a live session, where they worked through cases with an expert. The major difference was that the internet-based instruction was done at the learners' convenience, and often over several different sessions.
Learning increased for both the live and the internet-based instruction group, both immediately after the instruction and at 12 weeks.
Practice behavior only changed significantly for the group that received instruction over the internet.
This is kind of a surprising result, why should the internet-based instruction be successful, while the live-training was not.
One reason might be that the internet-based group had the chance to complete the instruction in a single sitting. This fits with the instructional principle pf spaced practice - that is - spreading the practice over a period of time, which gives people a better chance to learn the material.
Saturday, November 13, 2010
Cognitive Design for Online Medical Education
Richard Mayer has written a new article in Medical Education about applying the fundamentals of cognitive design to multimedia or online medical education. We know a lot about how to structure instruction to help people learn and Mayer's article is a very good introduction for people interested in learning more about how to do it. Mayer's writing has influence a lot of good multimedia design and his recommendations are all based on careful research.
Principles for instructional design include reducing the amount of extraneous cognitive processing (that is, processing that isn't related to the learning task), principles for managing essential processing (that is, processing that is related to the learning task), and principles for fostering generative processing.
These principles are probably best used for relative novices, or for an introduction to a subject but understanding these principles can help you develop online learning and even PowerPoint presentations.
Principles for instructional design include reducing the amount of extraneous cognitive processing (that is, processing that isn't related to the learning task), principles for managing essential processing (that is, processing that is related to the learning task), and principles for fostering generative processing.
These principles are probably best used for relative novices, or for an introduction to a subject but understanding these principles can help you develop online learning and even PowerPoint presentations.
Sunday, November 7, 2010
DevLearn 2010
I've just come back from DevLearn 2010, the biggest e-learning conference in the United States. The conference was packed with many interesting people and ideas.
There was a lot of talk about social learning. I've become increasingly convinced over the last several years that social media can be an important tool for learning in health sciences professional education.
I have several new books to read including the "Working Smarter Fieldbook" by the folks at the Internet Time Alliance. The book is filled with good information that will take some time to digest. I'm also getting ready to read Tony Bingham and Marcia Conner's book, "New Social Learning".
There was a lot of talk about social learning. I've become increasingly convinced over the last several years that social media can be an important tool for learning in health sciences professional education.
I have several new books to read including the "Working Smarter Fieldbook" by the folks at the Internet Time Alliance. The book is filled with good information that will take some time to digest. I'm also getting ready to read Tony Bingham and Marcia Conner's book, "New Social Learning".
Sunday, October 31, 2010
Redesigning Continuing Education in the Health Professions
A recent report from the Institute of Medicine (IOM) suggested several ways to improve continuing education in the health professions. The recommendations in the report would greatly improve the continuing education, especially for educational programs for teams of providers from different disciplines.
Some of the problems with the current system identified in the report:
Lack of Scientific Understanding of Effective Training
One of the things I'm interested in, and the reason I'm writing this blog, is to explore the science of learning and to look at how that has been, and can be applied to continuing education in the health professions. We know a lot about how professionals learn, but there is much more that we need to understand.
Fragmented Oversight of Continuing Education
Each discipline (doctors, nurses, social workers, psychologists, etc) has their own accreditation body and their own set of rules to follow. This isn't a problem if you're planning learning for only one group of professionals. More and more though, it's becoming apparent that teams of professionals who work together with specific patient populations, should be trained together. It can be a struggle to create an accredited learning experience, that meets the requirements for each of the separate groups, especially if you're trying to do something that is slightly unconventional.
Some of the problems with the current system identified in the report:
- a lack of scientific understanding of what kinds of training are effective
- fragmented oversight of continuing education
Lack of Scientific Understanding of Effective Training
One of the things I'm interested in, and the reason I'm writing this blog, is to explore the science of learning and to look at how that has been, and can be applied to continuing education in the health professions. We know a lot about how professionals learn, but there is much more that we need to understand.
Fragmented Oversight of Continuing Education
Each discipline (doctors, nurses, social workers, psychologists, etc) has their own accreditation body and their own set of rules to follow. This isn't a problem if you're planning learning for only one group of professionals. More and more though, it's becoming apparent that teams of professionals who work together with specific patient populations, should be trained together. It can be a struggle to create an accredited learning experience, that meets the requirements for each of the separate groups, especially if you're trying to do something that is slightly unconventional.
Friday, October 22, 2010
Internet-Based Learning is Just as Effective as Face-to-Face
If distance learning is well-conceived and carried out, there are no differences in learning based on studies comparing live training to internet-based training.
This is the major finding of a review published in JAMA in Sept. 2008 titled, Internet Learning in the Health Professions: A Meta-analysis. This paper was written by the research group of Cook, Levinson, Garside, Dupras, Erwin, and Montori, who have been writing a lot of very interesting papers on learning from technology in the health sciences.
They looked at 201 studies, some comparing internet-based learning with a no intervention group and comparing internet-based learning with a face-to-face alternative. They looked at three different outcomes: knowledge, skills, and behavior/ effects on patients.
What did they find? That internet-based training was no different than live training. Their findings are similar to publications from other fields showing that at worst, there is no difference between learning online and face-to-face learning.
The conclusion:
It's a waste of time to continue doing studies comparing internet learning with face-to-face learning, it's time to start looking at exactly what kinds of activities and instructional methods lead to better learning.
In future posts, I'll look at some of the things that you can do to improve learning and outcomes for your online learners.
This is the major finding of a review published in JAMA in Sept. 2008 titled, Internet Learning in the Health Professions: A Meta-analysis. This paper was written by the research group of Cook, Levinson, Garside, Dupras, Erwin, and Montori, who have been writing a lot of very interesting papers on learning from technology in the health sciences.
They looked at 201 studies, some comparing internet-based learning with a no intervention group and comparing internet-based learning with a face-to-face alternative. They looked at three different outcomes: knowledge, skills, and behavior/ effects on patients.
What did they find? That internet-based training was no different than live training. Their findings are similar to publications from other fields showing that at worst, there is no difference between learning online and face-to-face learning.
The conclusion:
It's a waste of time to continue doing studies comparing internet learning with face-to-face learning, it's time to start looking at exactly what kinds of activities and instructional methods lead to better learning.
In future posts, I'll look at some of the things that you can do to improve learning and outcomes for your online learners.
Thursday, October 21, 2010
Expertise
Over the last 25 years, there has been a lot of research on how people develop expertise. Our understanding of what expertise is, and how people develop it, has increased greatly. One of the leading thinkers on expertise has been K. Anders Ericsson. This literature is important because it can help us understand how to set up the conditions that can support expert performance within an organization, as well as helping us figure out ways to develop our own expertise.
Ericsson and colleagues wrote a paper for the Harvard Business Review that is a very good introduction to expertise: The Making of an Expert.
Among the highlights:
Consistently and overwhelmingly, the evidence shoes that experts are always made and not born. We often think that people have inherent skills and abilities but this just doesn't turn out to be true. Expertise is developed. Developing expertise in a subject takes hard work. In fact, the most important factor in studies of expertise are quality practice time – not inherent factors like IQ, learning styles, or anything else. This has been shown to be true for every field that’s been studied. The only exception is in sports where body size and height are important.
It takes time to become an expert – most people need a minimum of ten years of intense training. Ten years of simply repeating the same things over and over again will give you experience, but it won’t make you and expert. Expertise takes a constant drive to improve your own performance. This means focusing on the things that you things you need to improve on, not on the things you can already do well.
Practice must be deliberate. Real experts seek out constructive (and sometime even painful) feedback. The best way to improve is to constantly get, and act on, feedback about your performance.
Understanding expertise is important for anyone designing professional education experiences because we want to make sure that we're supporting the development of expertise.
For a more in-depth look at expertise (including a chapter on expertise in medicine), check out the The Cambridge Handbook of Expertise and Expert Performance.
Ericsson and colleagues wrote a paper for the Harvard Business Review that is a very good introduction to expertise: The Making of an Expert.
Among the highlights:
Consistently and overwhelmingly, the evidence shoes that experts are always made and not born. We often think that people have inherent skills and abilities but this just doesn't turn out to be true. Expertise is developed. Developing expertise in a subject takes hard work. In fact, the most important factor in studies of expertise are quality practice time – not inherent factors like IQ, learning styles, or anything else. This has been shown to be true for every field that’s been studied. The only exception is in sports where body size and height are important.
It takes time to become an expert – most people need a minimum of ten years of intense training. Ten years of simply repeating the same things over and over again will give you experience, but it won’t make you and expert. Expertise takes a constant drive to improve your own performance. This means focusing on the things that you things you need to improve on, not on the things you can already do well.
Practice must be deliberate. Real experts seek out constructive (and sometime even painful) feedback. The best way to improve is to constantly get, and act on, feedback about your performance.
For a more in-depth look at expertise (including a chapter on expertise in medicine), check out the The Cambridge Handbook of Expertise and Expert Performance.
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