“Dosing” medical knowledge: Beyond passive learning

Jeffrey P. Burns, MD, MPH, is Chief of the Division of Critical Care Medicine at Children’s Hospital Boston. He established and is Executive Director of the Children’s Hospital Simulator Program, one of the first hospital-based pediatric simulator programs in the U.S., and also co-chairs the hospital’s Ethics Committee. This post, second of three parts, is adapted from his recent talk at the IBM Impact 2011 Global Conference.

“Practice makes perfect” is an axiom that holds for most tasks, including providing health care to a critically ill patient.  And yet even if I’m in training for several years, the experiences I get and the experiences the person next to me gets are radically different – in fact, they’re very random.  I’m on one night, you’re on the next night, and what I saw last night, you won’t see tonight.

That’s no way to dose and sequence knowledge; in fact, no one would set up an educational program where you learned randomly.  There’s a troublesome paradox: Medical crises are relatively rare events in children, as compared with adults, and thus there are fewer physicians and nurses with the necessary experience in caring for critically ill children.

Every month, I get letters from all over the world – “Dr. Burns, can I observe in your ICU?” Last month, we’ve had somebody from Iran, Pakistan and Turkey. And yet we often must say “no,” because the walls are only so big. How can we best spread our knowledge and expertise?

About 10 years ago we started simulation. High-risk industries such as the airline industry, the nuclear power industry and now medicine are relying heavily on simulation to train people to think clearly and effectively in a crisis. We use it for everything – for orientation, crisis training, quality improvement. We use it to practice – and we want to take it to the rest of the world.

In designing a simulation learning system, you need to be aware of different learning styles. My wife and I recently got Smart Phones. I take out the instructions and read them before I start to use it. My wife, on the other hand, pulls hers out of the box, finds the “on” button and away she goes.

All adults basically fall into one of four learning styles. Look at the four quadrants below. The horizontal axis describes how adults like to acquire new information. The vertical axis describes how they like to put it in practice.Learning to use a SmartPhone, I wanted to watch people – “How do they use this thing? What is an app anyway?” Not my wife, she’s dialing things in right away. She’s in the upper left quadrant, I’m in the lower right quadrant.

In designing a learning system, we know that if we force you out of your natural quadrant and through the other three quadrants, you’ll imprint about 25 percent more of the material. That’s what the U.S. military, the airline industry and medical simulators do, even though the people being trained don’t know it.

First there’s Abstract Conceptualization. We give our trainees a short talk: “OK, here’s the concept.”

Then Reflective Observation: “Now watch an expert do it.”

Then there’s Active Experimentation and Concrete Experience. Then back to Reflective Observation: “Watch a videotape, think about what you’re doing.”

We’re forcing then through the adult learning cycle. And we’re dosing the information in a sequence that we think is appropriate to break down core experiences and build them out.

When I tried to find this kind of concept being used by others on the internet, all I found was videos, webinars… passive learning. You’re being dosed by a speaker.

About two years ago, I went home on a Friday night and there’s my son, 16-year-old Matt Burns, playing a video game. He’s on Xbox, and he’s got earphones on. And I say, “Matthew who are you playing with?” He names four boys I know and one I don’t know. I ask who the other is.

“Where are you?” he asks into his headphones. “He says he’s in Munchen, Dad.”

“You’re playing with a kid in Munich, Germany??”

I watched what he did.  Embedded in gaming are some very effective educational strategies. He’s playing in teams, and they’re forming a hypothesis, and then they’re executing their hypothesis. And they’re revising it as they go along and they’re communicating. The learner is controlling navigation, and it’s backed by really sophisticated analytics. The system knows the sequence the learner is taking, and it gives him several learning maps based on his degree of difficulty. This is brilliant educational strategy – and it’s in a game.

And then it was 2009 and Angel Cabrera had won Sudden Death. I don’t have time to golf, but I love to watch the Masters tournament. I go to the website and there’s Angel Cabrera streaming in high-def. There’s the expert explaining how he won the Sudden Death playoff. He won it on the Amen Corner – the 11th, 12th and 13th green.

Then I saw how he did it.  It showed his approach to putting the 11th, 12th and 13th green. And I thought, “That’s pretty interesting  — ‘See the expert do.'”

Then I saw this: an avatar: “Now you putt the 11th, 12th and 13th green.” Adult learning theory! And there’s also a social network to exchange information about what works and what doesn’t.

I thought, who powered this thing? I went to my assistant and said, “Find these guys.”

It was powered by IBM Interactive. I said, “Get them in here.”

And I told them my issues.  In the next post, I’ll tell you about our project, the Pediatric Intensive Care Unit (PICU) Without Walls.

  • http://twitter.com/MauraCrabassMcG Maura CrabassMcGonkl

    Terrific! As a previous frequent flyer of ERs & PICUs with complex medical kids [-s intentional], I think it’s great when education can address the need for training to manage this level & other emergent medical needs of kids- prior to our arrival. Great project.