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DESIGNING THE LEARNING INTERVENION

Tuesday, April 21, 2009

2:00 – 3:00 PM EDT

John Ruggiero, MPA, PhD

Vice President, Education and Outcomes

Institute for Continuing Healthcare Education

Philadelphia, PA

Instructional Design Webinar Series

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Faculty

John Ruggiero, MPA, PhD

Vice President, Education and Outcomes

Institute for Continuing Healthcare Education

Philadelphia, PA

Disclosure: Do not have an interest in selling a technology, program, product, and/or service to CME professionals.

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History and Rationale

The concept of instructional design began in World War II when generals were responsible to quickly train the masses

As a result, instructional design found a home within the foundations of psychology and sociology through cognitive behavior practices/models

In the forefront, for example: Cognitive Theory of Multimedia Learning1

Humans are programmed to consider both the auditory and the visual when tasked to learn.

Psychological research shows that we learn best when verbal information is presented with visual examples.

1Mayer, R.E. (1997). "Multimedia Learning: Are We Asking the Right Questions?". Educational Psychologist 32 (41): 1–19

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History and Rationale Continued

International acceptance of cognitive behavior theories led to the interest of applying this design to academics as well

Cognitive: what exactly do humans think?

Psychomotor: what exactly do humans do as a result of thinking?

Affective: what exactly do humans feel as a result of thinking?

2009: Debate still exists

Can you design instruction?

Can you design the outcome of that instruction?

Moving forward, we will discuss this debate and incorporate it into the current practice of medical education.

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Learning Objectives

Therefore, at the end of this activity, learners should be able to:

Relate instructional design to needs assessment and educational outcomes measurement

Explain role of Faculty, CME Provider and Learner in Instructional Design

Describe the re-engineering of the lecture and the use of interactivity in learning

Apply the instructional design practices in the learning experience

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Review of Adult Learning Theory

Pedagogy Strategies of instruction

Teacher- and subject-focused

Andragogy

Engaging adult learners in the learning process

Life-focused

Encouraging self-motivation and self-learning

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Adult Learning Types

Several models2 exist that demonstrate one’s ability to learn effectively

Didactic: the traditional relationship between teacher-student, where the teacher is the “expert” and the student is “recipient”

Visual: engaging the learner through presentation

Auditory: engaging the learner through lecture

Reading/writing/demonstration: engaging the learner through self-motivation

Kinesthetic/tactile: engaging the learner through experimentation and action

The role of any good educator is to find what model(s) best suit the learners

2Fleming's VARK model

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Adult Learners and Performance Change

If the goal of learning is to increase knowledge, and the goal of adult learning is to encourage its application

Then essentially all education is centered on performance change

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Ok, Performance Needs to Change? How Do I Start?

The study of Adult Learning Theory is new and vast

Yet a comparable theory on educational interventions can often be summarized into one statement:

Consistent reiterations are needed for learners to retain learning and actually make performance changes3

3King KP. Bringing transformative learning to life. Krieger; Malabar, FL: 2005.

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Applications to CME

Physicians are focused on consistently increasing competence

AMA Report on the Council of Medical Education4 claimed education needs to focus on:

Self-assessment of learning needs

Independent identification, analysis, and synthesis of relevant information

Assessment of whether information sources are credible.

Identify strengths, deficiencies, and limits in their knowledge and expertise

Develop learning and improvement goals

Identify and perform appropriate learning activities

4Richard J.D. Pan, MD, MPH. REPORT OF THE COUNCIL ON MEDICAL EDUCATION. CME Report 3-A-08

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Enter a new and valuable player…

…The CME Provider

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Educational Architecture: 3-Step Process

1• Continuous Medical Education

Intelligence

2• Development of a Needs

Assessment

3• Gap Analysis performed by adult

learning experts

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Designing the Learning Experience

Needs Assessment – Identify the learning gaps

Identify the target audience and their learning style(s)

Construct measurable learning objectives that will close the gaps

Hypothesize the end result of your education

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Example: Designing the Learning Experience

Needs Assessment: “…diagnosis of this malignant disease is often too late since first line responders confuse the signs and symptoms…only 3% of patients are reaching specialists in the appropriate time…data shows first line responders do not know how to best communicate with these patients…”

The CME provider should be considering the following:

1. Communicating is a key objective above. Therefore part of the educational design should include Experiential Learningtechniques, such as openly discussing ideas, guided teaching/demonstration, role playing.

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Example: Designing the Learning Experience

Needs Assessment: “…diagnosis of this malignant disease is often too late since first line responders confuse the signs and symptoms…only 3% of patients are reaching specialists in the appropriate time…data shows first line responders do not know how to best communicate with these patients…”

The CME provider should be considering the following:

2. First line responders are perceived to have a gap of knowledge. Therefore, primary care physicians (PCP) need to be invited as learners. However, if you add the subgroup discussion design to the learning experience, PCP learners could be paired with specialist learners to openly discuss/challenge ideas and thought.

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Example: Designing the Learning Experience

Needs Assessment: “…diagnosis of this malignant disease is often too late since first line responders confuse the signs and symptoms…only 3% of patients are reaching specialists in the appropriate time…data shows first line responders do not know how to best communicate with these patients…”

The CME provider should be considering the following:

3. A recognition of the factors that differentiate the signs and symptoms of this disease from common ailments should help drive the learning objectives for competence. The recommended learning experience tools: Observation examples, using writing assignments, and discussing responses with learner colleagues

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Example: Designing the Learning Experience

Needs Assessment: “…diagnosis of this malignant disease is often too late since first line responders confuse the signs and symptoms…only 3% of patients are reaching specialists in the appropriate time…data shows first line responders do not know how to best communicate with these patients…”

The CME provider should be considering the following:

3. From a performance change standpoint, only 3% of patients are reaching specialists in the appropriate time. Therefore the education should provide tools to assist learners with increasing this percentage to a better rate. The recommended learning experience tools: Using partners to role play, and creating a best-practice case study or check list for learners to use

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The Responsibilities of Learning

Reiterating pedagogy and androgogy, all parties in the educational process share responsibilities.

Faculty responsibilities

Goal Learning: faculty demonstrates how the learning will help the learner reach his or her goals

Practical Learning: faculty MUST demonstrate that the education is specifically designed for the learners

Motivational Learning: faculty demonstrate that this information helped them as well, and therefore learners should be motivated to accept the learning as well

Learner responsibilities

Self-direction: learners assume the responsibility

Conversion: the more the learning has an impact on the job, the higher the conversion. The responsibility lies with the learner to make this happen.

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The Responsibilities of Learning

CME Provider responsibilities

Design content that addresses clinical problems and encourages learners to move toward conversion

Design the learning experience to appropriately present the content to predispose, enable, and reinforce learning5

Who is the target audience and what adult-learning model will best help them learn?

How can the education best reflect the needs of patients?

Once the adult-learning model is chosen, which educational format and tools will help present best practices and help learners make a conversion?

Didactic? Simulated gaming? Assignments? Discussion groups?

What method will best enable learners to retain what they learned?

Interactivity, beyond the learning at-hand, for example…

5Moore et al. A conceptual model of CME to address disparities in depression care. JCEHP,

27(S1):S40-S54, 2007.

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Educational Engineering

Interactive educational meetings versus lecture-based (didactic) meetings

WHO Study, last revisited in 2003—The WHO Reproductive Health Library; Geneva: World Health Organization

2995 healthcare professionals

24 of the 32 studies included had reported a significant improvement in professional practice (for at least one major outcome) for those learning by interactivity versus purely didactic.

Helen Smith, Heather Brown, Jitendra Khanna. The effects of continuing education meetings and

workshops on professional practice and health outcomes: RHL commentary (last revised: 16 January 2003).

The WHO Reproductive Health Library; Geneva: World Health Organization.

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Interactivity

Regardless of the educational format, interactivity plays a key role in impacting: Learning

Performance changes

Measurements

Typical models include Automatic Response Systems (ARS)

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Interactivity Continued

Innovative models include Group discussion surrounding a topic

Revisiting an interactive conversation prior to the start of an educational activity

Designing question/answer sessions in a way that gathers data and allows learners to feel satisfied

Through a follow-up survey, reiterating the discussion topics

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Interactivity Example

Education on

the Relapsed Oncology Patient

One month Prior to the symposium:

Learners are asked to electronically provide a

response to a question that will be discussed further in the

symposium

At the satellite symposium:

Through ARS, learners are asked pre-questions, content-related questions, and post-

questions to measure immediate learning. Learners are further asked to revisit the

electronic conversation that took place one month earlier.

After the symposium:

Learners are asked to respond to the evaluation/post-test and

follow-up post-test

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Instructional Design Application Models

(Carey, 1990) The "ADDIE" model, which stands for Analysis, Design, Development, Implementation, and Evaluation, represents one of these basic models of Instructional Design

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ADDIE Model

Needs

Assessment

Medical

Education

Intelligence

Gathering

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ADDIE Example

Focus Determine educational need

Analyze requirements of learners, patients, and industry

Produce high-level educational design

Develop educational materials, infrastructure and milestones

Educate the learners Review and report the education effectiveness

Objective

Educational benefits and costs (money and time) are accurate

Learning needs and other requirements are accurately defined

Educational design satisfies requirements identified in needs analysis

Pilot program and implementation plan meet design requirements

Learner successfully complete the educational initiative

Evaluations accurately determine strengths and opportunities for improvement

Deliverables

Educational Plan of Action

Educational grant

Educational design tools that rationalize the chosen formats

Needs Assessment High-level Design Educational materials/resources

Evaluation instruments

Completed learner assessments

Completed attendance forms

Completed learner feedback forms

Initiative Evaluation Report

Adapted from the ADDIE Business Performance ISD model, © 2003-2008.

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Applying Instructional Design into Practice

Establish a welcoming environment From the onset, educational providers should develop a relationship with learners:

humans by nature are more comfortable with that which is known

Determine the essential components of the education Needs assessment data gathered from experts and learners

Provide clear expectations and feedback Whether the education is live or enduring print/Web materials, learners should be made

aware of not just the learning objectives, but of the learning experience development and the need to measure competence and performance

Consider ways to incorporate reinforcement of learning Use varied instructional methods

Provide a variety of ways for learners to demonstrate knowledge

Use technology, when necessary and available to enhance learning opportunities

Encourage faculty-learner collaboration Encourage the development of continued question/answer sessions between ―teacher-

student‖

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In Summary

Instructional Design is a systematic methodology to develop a route to effective education.

In the past, the primary emphasis was often placed on the training rather than on the learning.

Now, needs assessments, quality performance information, best practice data, adult-learning models help the educational provider drive the overall learning experience

Like therapies, various learning models exist

The goal is to address the individual needs of the targeted learners by testing and measuring the available learning models in order to encompass a complete and effective learning experience

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J O H N R U G G I E R O , M P A , P h D

J R U G G I E R O @ I C H E . E D U

Q&A

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