By Andrea L. Gaymon, MEd, and Kenny Cox, CHCP
It goes without saying that since March 2020, every sector of the healthcare industry has been impacted by COVID-19, and that includes medical education. Shifting to virtual over live education and expanding on-demand online educational offerings are crucial to address the needs of healthcare practitioners who want to stay up to date with the latest clinical information.
As a community, CME professionals have always been taught that a one-size-fits-all approach does not work for everyone when it comes to learning, and our educational initiatives should reflect the needs of our learners, meeting them in the context of the current situation. Today, the current situation is one in which HCPs are adjusting to new workflows and learning challenges brought on by the impact of the pandemic.
Microlearning, a format often used by learning and development professionals outside of CME, is showing promise as an option for time-deprived practitioners. However, a recent survey conducted at the CBI Grants Conference showed a lack of understanding of what microlearning is, with only 22% of respondents correctly identifying microlearning components. In this article, we will explore the use of microlearning and provide a few best practices and use-case examples for how the format can be used in CME.
What Is Microlearning and Why Is It Effective?
As noted, although microlearning has sporadically been used in CME as an effective learning model, it has been used for decades in other industries as work environments have transitioned from in-person training to e-learning (Boring 2020). Kapp defines microlearning as “an instructional unit that provides short engagement in an activity intentionally designed to elicit a specific outcome from the participant,” (Kapp 2019). Microlearning can involve short-term, focused strategies to support skill-based learning, as well as supplement, reinforce, augment or remediate a larger training initiative. The format allows participants to digest information more easily and encourages learners to take active control of their education, improving overall retention and comprehension (Avery 2016).
When developing and implementing microlearning interventions, a few fundamental best practices should be considered, including:
- Limit focus: Activities should be limited in their scope, focusing on a single learning objective (topic, skill or behavior), not multiple objectives.
- Limit timing: Microlearning activities should be short in duration, aligned with learning in smaller chunks that can be consumed quickly. This might be five minutes, or it might be 30 minutes, depending on the objective of the education.
- Use a variety of media: Videos, infographics, gamification and audio are all formats that can be used to build effective microlearning activities.
- Implement spaced retrieval: Space out the education and use a variety of touchpoint techniques with the learner to help with recall of information over periods of time vs. cramming a lot of information into a small window.
- Make it part of a larger initiative: Microlearning can be extremely effective when used to supplement, reinforce, augment or remediate learning within a larger initiative.
- Assess the right data: When assessing the education, make sure to align measurements of success with the impact of what is expected from the design of the microlearning activity.
When building microlearning education, it is beneficial to consider a specific use-case. Use-cases are different from the type of microlearning activity and are determined by a few key factors: how we learn, the type of skill or information we are learning and the complexity level of the skill we want the learner to achieve.
Types of microlearning are more dependent on the environment for delivery of the education, the learner’s preferences, the timeline and the budget. Six core microlearning use-cases should be considered when planning your microlearning activity: performance-based, persuasive, pensive, post-instruction, practice-based and preparatory (Kapp 2019).
Often referred to as “just in time” or “point of need” learning, performance-based instruction is focused on teaching a specific task or skill. For this education, learners should be able to clearly identify the task or skill, understand what materials or tools are required and be instructed on how to perform the task. Probably the most widely recognized form of microlearning with numerous published studies, performance-based is probably best known by the extensive library of DIY videos on YouTube. Learners can find education on how to perform numerous tasks from fixing a sink to learning how to braid a new hairstyle. This use-case also provides tremendous opportunity for addressing the educational needs of HCPs. Consider a brief video on how to properly administer a vaccine or conduct a diagnostic test. Performance-based education should be a key consideration when implementing microlearning activities.
Persuasive microlearning is seeing a surge of use in the medical space, especially with patient education. The persuasive use-case is designed to engage and encourage, nudging the learner into proper behaviors. This can be clearly seen with how HCPs are embracing the use of text messages to send patients healthy tips and reminders, all of which educate, improve adherence and support healthy habits. A study published in Diabetes Research and Clinical Practice showed that health-related text messages sent to patients with diabetes had a significant positive impact on their overall disease management (Nanditha 2018). The persuasive use-case can also be applied to reminders sent to HCPs, providing additional information, help overcoming barriers and nudges that drive enhanced practice behavior.
With any education, reflection by the learner is a key element. Microlearning that applies a pensive use-case can guide learners through this process, encouraging them to think through new ideas and concepts while reflecting on their own prior body of knowledge. Activities employing this use-case often include a series of questions that lead the learner and guide them through the process, engaging them to slow down and reflect, to consider application of new concepts and to provide feedback to the education provider.
Often designed to support a larger training initiative, the post-instruction use-case builds upon the learner’s base of knowledge and bends the “forgetting curve,” improving overall reinforcement and retention by applying spaced retrieval concepts of sending materials out at various times after the activity has been completed. In CME, we are all familiar with sending out post-instructional materials, such as surveys, practices pearls and other materials that reinforce learning, which all fit within the post-instruction use-case. Supporting materials are key and often offer the opportunity for the education provider to apply agile design concepts and enhance crucial concepts that may unexpectantly need reinforcing from the larger training initiative.
Microlearning is particularly helpful when participants are sent reminders and support materials to help coach them, using a Practice-based use-case. Often tied to a persuasive use-case, practice-based encourages the learner to take deliberate practice steps, breaking down a skill or behavior change into small deliberate steps. Numerous examples of this technique are available, especially outside of CME. Recent emergence of language-based apps is helping a new generation of students to learn a foreign language virtually vs. attending a live class. Apps such as Duolingo and Babbel use short, bite-sized lessons that allow people to engage and be coached, while also providing quiz-based gaming and animation tailored to participants’ needs.
Whereas post-instructional microlearning focuses on reinforcing additional learning, Preparatory microlearning focuses on level setting participants before they engage in a larger training initiative. For example, medical conference organizers could choose to apply preparatory learning to their attendees by sending them in advance various educational materials that improve their base level of knowledge, preparing them before the conference. Formats can vary and may include videos to watch or articles to read, but with all content, learners should be able to choose their own path, and use of microlearning best practices would be crucial.
Assessing the Impact
Assessing microlearning can be accomplished with a variety of methods, such as multiple-choice questions pre- and post-testing, application of patient vignette scenarios and reflective free-text questions, measuring knowledge, competency and performance change across qualitative and quantitative data. Leading data, collected at the time of participation in the activity, can be enhanced by looking at learner engagement measures as well. Understanding such elements as time spent in the content, actions taken while participating in the activity and the number of times a learner accessed the content demonstrate a level of detail that provides a more comprehensive analysis of the impact of the education and whether learners were reinforcing or improving on their existing knowledge, competency and confidence. Lagging data, generated from follow-up surveys, can specifically address performance change and identify barriers that have kept the learner from implementing suggested changes, providing a variety of insights that would help direct additional educational needs.
As with all microlearning efforts, assessment tactics need to use microlearning best practices, including maintaining a level of brevity. Having a 15-question pre- and post-test for a 10-minute activity, or even worse sending that 15-question test in a post-activity follow-up survey, would challenge the most engaged learner and reduce the level of learner engagement. Make sure that your assessment tactics fit within the overall concept of your learning design. And always make sure you follow a “begin with the end in mind” approach that ensures all assessment measures are planned and designed at the beginning of your initiative, tying back to learning objectives and fitting within the overall design of the education.
Microlearning concepts provide a variety of opportunities for CME providers to enhance their current educational offerings with the goal of supporting learners and their needs. By taking time to appropriately plan and map out the intent of the educational initiative, including applying solid educational design concepts, microlearning can be an effective tool in your educational portfolio.
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