It’s about the thinking skills, not the information

A recent TED Talk by Diana Laufenberg, a social studies teacher, makes an important point about what, and how, students need to learn. She teaches younger students but I think her ideas hold for adult students as well. 

They don’t need experts for information anymore, information is all around them.  What they need are to develop thinking skills.  Laufenberg’s grandmother needed to listen to her teachers to get information.  Laufenberg grew up with the advantage of encyclopedias as an additional information source.  Her students have huge amounts of information literally at their fingertips. 

They don’t need a teacher to tell them facts, they need a teacher to help them develop skills to use the information already available to them.

Coaching and Practice Improvement

Does learning lead to practice improvement?  I have done some learning research, and I used to think that learning was the really important thing.  If we carefully designed our instruction to maximize learning, that meant that people would be able to use that knowledge to in their work. 

Experience and a much broader view of the learning literature though, has taught me that improving people’s work performance is not always simply about learning.  Sometimes, helping people perform better at work is like helping them change their behavior.  And behavior change is hard.  Smokers all know that they’d be better off quitting, and we all know that losing weight is as easy as exercising a little more and eating a little less.  It’s actually using that information and knowledge that’s the hard part. 

Recently, I've been thinking of performance improvement a little more like behavior change.  It often takes more than just a learning session or two to make an improvement and there may be times when people need a lot more than just learning a new skill.  They may need a little more help and coaching to use their new skills in their jobs.  

A recent paper (JAMA, 2010;304(15):1693-1700) discussing the adoption of surgical safety procedures shows the effect of coaching after the learning intervention.  The surgical teams learned to use new safety techniques by a three step process – planning for the change at the facility, a one-day training where the teams got a chance to practice their new skills, and follow-up coaching by phone.  The intervention was successful. 

The interesting thing was the effect of the coaching.  Teams that got more coaching had had better scores on safety measures in a clear dose-response effect:

Of interest is the dose-response relationship between the number of quarters the training program had been implemented and the rate of surgical mortality. As facilities implemented longer, their rate of surgical mortality decreased further. This suggests that it is critical not only to provide training but also to ensure that the tools are fully integrated into the surgical service. The year-long follow-up was helpful in ensuring that OR clinicians adopted the training tools and changed practice patterns.

Improving performance may sometimes involve more than just teaching people new skills, you may need to help them adopt those new skills as well. 

Informational Videos

Short videos can be a great way to get information across.  Videos don't have to be overly produced to be effective, oftentimes, simplicity and a clear message are the most important things. 

I am a big fan of the videos made by Common Craft.  Common Craft makes 3 minute explanatory videos that are very good example of the effectiveness of clean, simple, but very carefully designed messages.  Their approach is so basic in fact, that at first, it almost seems like a joke or a gimmick.  Watch a few though, and you can't help but be impressed.  My favorites are about insurance, passwords, social media, and Twitter. 

They follow some consistent design rules:

1. Each picture has a purpose.  Each picture has been carefully selected to communicate a clear message.  There are no decorative pictures or anything else to distract from the message.  Designers sometimes like decorations and decorative pictures, but studies have shown that they can decrease learning. 
2. The videos have useful metaphors that are used throughout.  The insurance video uses a life preserver metaphor.  It would have been easy to use the metaphor once and expect the user understand. Much better though, to use it throughout the video so that it becomes reinforced as a powerful, and simple symbol. 
3. The people are about as generic as they can be.  They often don't have faces, or distinguishable genders but it turns out that they don't need to. 
4. They're short.  Three minutes might not seem like a lot of time to explain a complex topic, but it can work. 

VA's new Simulation Research Center has a Good Overview Available

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. 

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. 

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.

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".