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Curbside Consult with Dr. Jayne 10/13/14

October 13, 2014 Dr. Jayne 2 Comments


We are in the process of adding a variety of self-directed learning options to our EHR training. Up until now, we have had formal classroom training for clinical support staff and practice-based group training for providers.

Although we’ve had good outcomes from training, our paradigm is fairly resource-intensive. Additionally, providers complain about the time they spend in training sessions since it often cuts into their office hours even though we offer sessions before and after typical practice schedules.

One of the advantages of a resource-intensive training program is that it is the resources are intensely involved. When we train in small groups, we can provide individualized attention and can monitor who is catching on and who might be struggling. We can also ensure immediate follow up if attendees don’t pass our competency exam.

In turn, our learners can provide feedback on the effectiveness of our curriculum and presentation style so that we can modify it if needed. This is important when we bring new specialties live that our trainers might not be as familiar with as they are with other specialties.

We’ve had online refresher training for the last several years. It’s largely in the form of recorded web presentations, although we have a number of clips that were done with Adobe Captivate. They’re tied to our learning management system so we can see how many times each piece has been viewed and whether a particular employee is taking advantage of the resources. Managers can access a report of their employees’ activities, but the sessions are not required.

Our goal was to create some 5-10 minute segments that people could watch if they were having difficulty with a particular functionality or a new feature. Feedback has been good.

Given the budgetary pressures facing healthcare organizations, we’ve been asked to enhance our online offerings with a goal of reducing classroom training time. Staff will now be required to view a core set of e-learning offerings and managers will be responsible for tracking compliance.

I’m in favor of e-learning because it can be completed at the employee’s preferred time and location. However, I’m concerned that since reduced training time is the goal, that employees will be shortchanged. I can’t see some of our managers carving out protected training time for new employees. In particular, I know some of them will expect employees to jump right into patient care and learn the EHR on the fly.

Those same managers are likely to expect employees to complete the sessions on their own time even though that’s a violation of company policy. Staff working on uncompensated time might rush the training, or worse, multitask their way through it, diminishing mastery. We have a plan to gather data on whether the new strategy is effective, but based on the number and frequency of new hires, it will likely be six months or more before we know if it’s equivalent to our current platform.

I don’t like the idea of experimenting with our practices. We’ve worked hard to have a successful program and our practices get up to speed very quickly with only rare exceptions. Although we pull new hires out of the office for several days of training, when they return to the practice, they’re able to hit the ground running.

I guess my biggest concern is that there’s really no way to shortcut the material. A trainer — whether in person, recorded, or as part of an e-learning platform — can only impart information so fast. In turn, learners can only absorb so much in a given amount of time.

If this was an experimental drug, we’d first have to experiment on healthy subjects (or those who didn’t really need the training) to make sure it was safe. If it passed those tests, we’d have to experiment on more subjects to determine if it was more effective than placebo. Finally, we’d have to have a limited head-to-head trial against current training standards to determine if we should switch to it or not. Only if it passed certain statistical tests would we use it to replace our current training platform.

Since this is mostly about saving money, you can bet we didn’t have the opportunity to really study the new approach, let alone have an actual pilot or trial. We are being forced to switch everyone over without proof that it’s not going to lead to problems. As normally happens in healthcare IT, we were given a short deadline and limited budget to get it ready.

We’ve been in the business of delivering the impossible for a long time, however, so we’re up to the challenge. As for outcomes, only time will tell.

Have you been able to pare down training and maintain quality? Have great ideas? Email me.

Email Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. Personally, I think you’re really on to something here. The issue with moving from in-person to at your own pace is focus. Everyone lives very busy lives and multi-tasking is the norm to determinant of understanding. There will be some people who have the same level of understanding, but the vast majority would have been better off with in-person training.

    I really enjoyed the book “How will you measure your life?” because it points out prevalence and harm looking at everything based on cost benefit analysis. Some things take a long time to pay off like raising children or training great staff. You may think you’re “saving money” but if eliminating in-person training causes more on the job training and mistakes you’re not really saving anything.

    A few years ago I was invited to a demo for a virtual reality cave (which in itself is really impressive). The technology is cool and the 3D images are impressive. However, the staff said the real benefit wasn’t the 3D. In fact many times they would switch back to just a flat image once everyone had their glasses on because to some people the image made them woozy. The benefit was that getting everyone in the same room and taking away everyone’s cell phone forced people to have a real conversation without disruption.

  2. The pros of self-directed, video learning:

    1). Run the training when you like. Great flexibility under every delivery model;
    2). The ability to stop, go back and reinforce on the spot;
    3). For the shrinking violets among us, no classroom pressure.

    The cons:

    1). You are generally in your place of work. Separating yourself from the workflow and letting others know that you aren’t really “available” can be impossible;
    2). There’s a level of interest and self-discipline that is required. For some topics and some people that’s going to be a problem;
    3). Some of the students will do better with the social reinforcement of classmates and an instructor.

    In general, I tend to view classroom training as superior when there’s a lot of material or it’s very new to the attendees. Also when it comes to busy and noisy workplaces, separating yourself from that can invaluable. Finally, classroom trainining sends an implied message that “this is important. Pay attention and stop checking your smartphone/e-mail/Facebook/Twitter/whatever!”

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