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Online Medical Education
1. Resuscitate Your Online Medical Education: 4 Vital Signs Presentation slides will be available at www.slideshare.net/enspirelearning/online-medical-education A recording of the webinar will be available at http://www.enspire.com/about/webinar_online_medical_education Please allow 24 hours for content to be posted. If you experience technical difficulties during the presentation, please send a message to the organizer through the “Questions” field at right. Please enter questions for the presenters through the “Questions.” These will be answered at the end of the webinar.
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5. World’s largest specialty nursing association 120,000+ members and non-member customers Only association for acute and critical care nurses in the United States AACN
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8. How we’ll get there AACN’s Mission As a leader in establishing work and care environments that are respectful, healing and humane. AACN
9. Patients and Families Acute and Critical Care Nurses Members Board of Directors Collaborating Organizations Committees Work Groups National Office AACN
20. Develop and diffuse knowledge AACN Preceptor Training Palliative Care and End of Life NEW
21. The 2 P’s The Preceptor Challenge The AACN Preceptor Development Program Promoting Excellence in Palliative & End-of-Life Care An Interactive Learning Experience from AACN AACN
50. Vital Sign 2: Engaging Storyline and Scenarios – Real emotions
51. Vital Sign 2: Storyline and Scenarios – Varied issues
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55. Vital Sign 3: Purposeful Interactivities | Resuscitate Our job is to help people: Learn? Solve problems? Solve problems in the real world! (Cathy Moore)
74. Vital Sign 4: Intentional Use of Media – Continuity challenges
75. Vital Signs for Continuing Medical Education Comprehensive analysis and design Engaging storylines and scenarios Purposeful interactivities Intentional use of media
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Editor's Notes
As most of you know, these are the standard most accepted 4 vital signs in medical settings: Body temperature, pulse rate (heart rate), blood pressure, and respiratory rate. This is what health care staff most need to monitor and ensure are in a healthy range in order for an individual to be deemed healthy, robust, quick – as in living, and otherwise in fine enough fettle, In our base-touch call yesterday Justine reminded us of the fifth vital sign; that sign being pain, so I wedged it in here. But the point is, these are our most important – indeed, vital – vital signs.
So then the question is, can we find similar vital signs for continuing medical education? What can we measure and ensure s in a healthy range so that we can continue to make good medical elearning? Apart from any awards, and we did take home a gold from Brandon Hall, this course was very well-received by its target audience, and Justine will actually reveal some very specific feedback we received as we near the end of the webinar, but also important to state here is that from a writer and developer’s point of view, and I feel confident that Jan and Justine will second and third this, this course was incredibly successful throughout thee entire design and development process, top to tail. Not all projects are always so successful. It was a joy to work on, so there are definitely some aspects of the course, project, and partnership that are worth replicating.
So the four or four and a half vital signs we identified for continuing medical education include a comprehensive analysis and design process, engaging storyline and scenarios, purposeful interactivities, intentional use of media, and all of these really gathering under the umbrella of a stolid partnership between clients, vendors, subject matter experts, and other folks working on the project. We’ll go through these piece by piece. Trading off and leaping in as necessary.
So, first, I’d like to talk about Comprehensive Analysis and Design process.
So our job on the development side is not to design merely information or instruction, it’s to design a whole experience!. I stole this and paraphrased this from the esteemed Cathy Moore, and must give her credit where it’s due.
We are all probably to some degree aware of some of the risks we face when creating elearning, and particularly very, very specific elearning – this one truly being much about life and death. There never seems to be enough time up front to plan and design from top to tail. And we need time. Another interesting possible peril we face when partnering, the SMEs know the content, but can potentially lose sight of the experience. Meanwhile, designers may know the principles, but not the audience and their reality. There’s a balance there that requires important collaboration, and importantly, that collaboration as to continue for the duration of the project.
So how did we address this risk? How did we resuscitate?
We got this project off on excellent footing thanks to a two-day design workshop in July of 2007. Justine flew in and we basically locked ourselves into the first floor conference room at Enspire with representatives from all our design areas, instructional strategy/content, MM, tech, and a project manager, and I believe even QA made an appearance. During the course of this workshop we all discussed what I like to think of as the four corners of creation: Who is the learner?, What are we teaching? How to motivate the learner? And How to make it interactive?
Identifying the learner was our first step, and this segment is actually stolen from the Palliative Care course’s sister – The Preceptor Challenge, which we also designed during that workshop. But this is a pretty good representation of the learner base we were working with. These are busy health care professionals. They care about their patients. And they are working with dying patients. And to a point that Justine made at the start of this presentation, this course was designed with two very specific goals: To integrate palliative care into all care settings, not simply end-of-life-care (which it is often considered synonymous to). Really to validate it in all settings. To provide realistic virtual world with decision making scenarios like the ones nurses would encounter in the real world, to ease the amount of distress nurses doubtlessly would (and will) and do experience. A place to practice and prepare. This is where I see online medical education’s real call to arms. Consider the first rule of medicine, Primum non nocere (excuse my likely destruction of the Latin, but first to do no harm. And you can’t hurt a virtual patient. Rather, you can, but you can learn from your mistakes and port that learning to the real world. The same is true for the learner themselves – this course teaches them to not only care for the patient, but to also care for themselves as they enter the real world hospital environment.
So we had this very fruitful two-day brainstorming session, later followed up by a kickoff with multiple nurse participants, but during this initial round, we brainstormed a few of the coolest features of the course that I’d like to show you in the next series of slides. One was AACN Virtual – our virtual hospital. As you know this course had a sister, and thinking about this big picture – how the courses worked together in a larger curriculum, we were able to make some decisions that united these courses, like the virtual hospital. This is actually a local hospital here in Austin with whom we have an excellent working relationship, and they were happy to collaborate with us and let us use their space for shooting photographs and video. As you can see, one of our MM gurus, likely Vu, mocked up the stylized name and logo side. But this virtual location was literally and figuratively grounding for the course, and made the course feel that much more real.
We also determined that one of the ways the AACN learners are most accustomed to learning was in discussion with other nurses, and we wanted the course to capture that as well, so we decided to use a virtual mentor to mimic that. This is Carla in real life. . .
. . . Lydia in the course, and she exists not in the plotlines, but in the virtual space as an expert and a guide. She personalizes the course and presents the material in a way learners are accustomed to learning in the real world.
Justine often refers to the 4 C’s that informed this course at its most foundational level. Comfort, Care, Communication, and Caring for the Caregiver. The last one, caring for the caregiver, is and was really a pretty revolutionary idea and something we wanted to include and address throughout the course, so we created a self-care meter. This interactive feature remained persistent throughout the three hour curriculum, a persistent temperature gauge for the user. When we get to our section on interactivities, either Jan or myself will discuss this more, but during this design workshop we were able to identify this need and create this self-care meter feature to address it.
You’ve seen a bit of the build out in those previous slides, but it’s also kind of fun to peek behind the curtain at the scaffolding/bones of development, again, what was the direct result of our comprehensive analysis and design workshop. This slide and the next show some interim deliverables that we passed back and forth with AACN.
They’re not as pretty or colourful, but they are evidence of this fully iterative analysis and design process on which our teams combined forces, and really made for this project to fly.
While I don’t want to drag you through all the design documents, for those of you who are writers or have not had a look at the course, these are the components we decided upon during the workshop. This what we first wrested onto paper as we began designing. So you can see from this menu, if this is your first glimpse, we are dealing with some pretty important, profound, complex, and painful subject matter.
People like stories. We are storytellers. Want to be involved. We care. Real people. Real lives. Real situations. Based on real life experiences. Books, cinema, water cooler… It’s how we experience life and how we learn.
Minds are not buckets you shovel knowledge into. Learn by experience. Our aim was to create learning experiences that learners would WANT to be a part of. Challenge: busy target audience, dislike CME already, don’t have time for a long course, First step. Start with solid evidence-based protocols.
AACN Protocols for Practice: Palliative Care and End-of-Life Issues in Critical Care sets forth the evidence-based guidelines for providing appropriate care, whether aggressively life-saving or palliative end-of-life care. Critical care nurses spend more time with patients and families facing the end of life than any other health care professional. Nurses are intimately involved in all aspects of end-of-life care and they are in position to address the variety of needs facing individuals at this juncture. Expert nursing care has the potential to greatly reduce the burden and distress of those at life's end and the ability to offer support for the many physical, psychological, social, and spiritual needs of patients and their families. The Protocols equip critical care nurses to effectively manage the following: * symptom management * family issues and intervention * withholding and withdrawing life support * communication and conflict resolution * caring for the caregiver Additionally, the text includes a state-of-the-science review that provides guidance to critical care nurses while acknowledging the limited evidence-based research that exists.
Characters with lives: This is my skill set. I know these people. I know their families, their history. (Lois is a retired school teacher.) Chloe – brain tumor, undergoing radiation and chemo therapy Ruby – dementia, feeding tube. Nursing home won’t take her back unless she has the tube Lois – admitted for wound management, nose dive. Now intubated and on ventilator for 10 days Ignacio – came in with suspected subarachnoid hemmorage. Later results in brain death. ( Carl – COPD lung disease : “skin and bones” Benefits: emotional hook, sense of reality, invested in story (continue the course) Story – Carl cancer – stroke of a pen, now he has COPD
Palliative care nurses don’t just deal with patients. But families, too.
SET THE SCENE – FACE THE ISSUES – COME TO RESOLUTION This description of the profluent plot has also been traditionally represented by the graphic below, called the narrative arc. The horizontal line represents the forward progression of the story page by page (that is, events in the order that the author presents them). The curved arc represents the level of dramatic tension in the story
Decision points – what do you do now? Genuinely feel as though you are called upon to make a choice. See the person’s response. He was alive when he came in. He was just talking to us.
We worked with AACN to create scenarios based on real life experiences. Didn’t shy away from, confused patients, angry family members… This is the son of the father with COPD. What would you do?
Decision points that feel real provide greater buy in. Different rooms different issues. With this family, for example, the mother didn’t speak English. How do you deal with a language barrier? (we actually cast a translator to be brought in later, by one of the interactivities) Also needed more characters (out of scope) put them on the phone. Son is constantly on the p hone with family members.
Traditional elearning, or less imaginative elearning, is typically point, point, point, quiz! Interactivities are too simple, not challenging, and not realistic. Multiple choice questions, at their worst, are often rooted in the theoretical world as opposed to the practical world. When you are in the patient care setting, is really just a choice between A, B, or C? More the type of situation of. “What would you do if. . . “ This helped us sidestep the, “Not another multiple choice!” reaction, as well head off the mindset of, “I just want to skip to the end to get my 80% passing and move on.”
So how did we resuscitate?
Here’s where I refer back to Cathy Moore once again, and again, I am paraphrasing, but sometimes it helps to get back to the fundamentals and ask again, “What is our job as online educators?“ Is our job is to help people learn? Kind of vague and not real measurable. Maybe our job is really more about helping people solve problems, and further, to solve problems in the real world.”
We needed to capture real-world challenges. Rooted in the real, rooted in the story. “What do I need to do in this situation with this patient?” So we needed to create a series of narratives that resonate. Make it personal. Make it realistic. Make it useful (good practice). Following the design workshop I spoke about at the outset was our kickoff. And we concluded the kickoff – once again we were lucky to host the AACN crew back in our Austin office, completely enraptured by the AACN team’s story after story after story of the patients they had had the good fortune to meet, the families they worked with, the situations they faced, and particularly in this course, the patients who they had carried through this “trajectory of death”.
And I recall myself, Jan, Kara, all folks on the Enspire team uttering, by instinct, all these euphemisms for death; passing, ceasing, expiring, going over, departing, becoming lost, etc. I’m sure you have a list as well.
And each nurse, every time we did, would hat the conversation and remind us; “It’s die, death, and dying. We need to face it head on and honestly. You lose your keys and your wallet and your lunch money. People die.” And this fundamental honesty was a cornerstone of the philosophy of the course – preparing nurses for these very real situations where patients were not “going to a better place” or “meeting their maker.” They were dying.
Instead of the “point, point, point, quiz” model, it was our duty to create an immersive experience; a stream of activities that carried the necessary information. Capturing the correct results-oriented decision points. Some of the ways we did this were with self reflection interactivities. So the user could explore, How do I feel about this? And I’ll show examples in the next slides. We also use ordering: Not right or wrong, but making it custom/personal. We employed exploratory or “Sandbox-style” interactivities, again, in keeping with that first law of medicine, the Hippocratic oath, “First, do no harm.” You can’t hurt the virtual patient. Also, less explicit interactivities but important interactive features are the course itself as a resource: Revisit for “brush-up.” And also as a repository for other resources: a centralization of tools.
Interactive menu: Upon rollover the patient overview becomes visible, kind of a thumbnail of their chart/diagnosis/story, so that the user knows whet they are getting into. In addition, this menu reminds the user upon revisit, who is who, and where they are so they can quickly navigate there for a review. The use clicks to begin working with that patient.
This is an example of a meaty multiple select. The user remains in the environment – they re not swept to some templated, other-worldly apace. They stay with the patient and explore in this safe place to practice
This is an example of a drag and drop or sorting interactivity. The user stays in the environment with the patient, reviewing and assembling the many moving parts simultaneously, very much as it is in real life.
And finally the self-care meter; the user’s internal temperature gauge that runs from 0-100. At the start of the course the user customizes this feature with their own preferred methods of self care, be it yoga, running, dinner with a trusted friend. And if they don’t halt their progression through the course modules fairly regularly to take a break and be kind to themselves with an activity uniquely for them, the self care meter will run down, and the course can even halt altogether. Not until the user acknowledges and tens to their own needs are they allowed to pick up in the lives of their virtual patients.
This meter was on the learner’s screen all the time. Every decision (or stressful scene) made it go down. If it got too low the course stopped until learner refueled.
Talk a little bit about why we used video? Why stills? Why this art style? Why not illustration or stock photo? Why such high end video and stills? When to use video – high end? Low end? Trade offs? When to use stills illustrations Risks of video Risk mitigation
Glitzy media – can make you think it’s a good course or good training upon first glance. And everyone might say what a great course it is, but when you look at it realistically, the instruction – the core learning experience – isn’t there. Our job at Enspire was to create a course with both . Put some pants on your learning!
Many options Text only, illustrated, sketches, Pros and cons We’ve used illustrated style for many courses. Settings need to change, sense of fantasy, multiple characters in multiple environments. Can be playful.
We chose realism of photography because we believed that this would draw the learner in more to the experience: and thereby have a greater sense of practice and application of the protocols. the whole point was the EXPERIENCE.
Another comparison between art styles. See why the “real” room was chosen? Again no right and wrong overall. Just want to do what is best for target learner and message
Enlarging this view so you can see the many pieces of equipment, monitors, etc… Big risk in doing a real shoot rather than illustrating it – or even just still photography. Scout location: hospital? Build a set? teaching lab on weekend Props, equipment, what’s showing on the equipment… SMEs on site
Intentional performances, filming, lighting…. Make a huge difference in the level of reality for the program. Who are you going to believe? Stock photo or these people? RISK – soap opera, overdone, cheesy Genuine emotion – not overdone, real Importance of professional casting, actors, camera, lighting..
Casting Casting couples that “match” Professional set designers --Props, art, and set Importance of continuity and coordination: storyline, medical content , interactivities, and set design (example, radio in shot, teddy bear. Not in video, but in interactivities. ) Lighter, brighter room
This is a shift into talking about the process of media production . It began with the script, then casting. Intentional casting: Casting families Son staying in character for hours for 2 lines Wardrobe, lighting, makeup, professionals on set the entire time.
Example of hot spot interactivity and video scene. Television had to be on (news station) in the video so that in the hot spot and other interactive options, the learner could sugg Continuity challenges: some concepts were taught in the interactivities (stills) and some in the video. Challenge to make it all sync. For example, no where in the video does some one bring the little girl a teddy bear. And yet there is to be a bear in the final resolution scene. est that the parents it off or change the channels to something more kid-friendly or soothing.
1. Comprehensive analysis and design 2. Engaging storyline and scenarios 3. Purposeful interactivities 4. Intentional use of media
Rather than go through this effective partnership vital sign, because this is been the underpinning or all the experience, or maybe the umbrella I think I said at the beginning, I’ll skip the risks and resuscitation steps, and instead, ask for Justine to describe some of the personal responses she has received. What the nurses said. . .
Just a quick review of our vital signs; again, comprehensive analysis and design, engaging storyline and scenarios, purposeful interactivities, intentional use of media, and effective partnership
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