Learning by Doing: A Model that Works in EHR Training – Breakaway Thinking

The following is a guest blog post by Todd Stansfield from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield
I didn’t learn to change the oil in my car until I changed it. My father instructed me a dozen times, and I watched him a dozen more, but it wouldn’t resonate until I got my hands dirty. I can count an endless number of other tasks that never stuck with me after reading about them in a textbook or hearing about them in a classroom. Some things I need to learn by doing; and I’m not alone.

Why is changing oil different from learning about the Roman Empire? Even years after taking history in college, I still know the story of Romulus and Remus. I can tell that story with the help of a knowledgeable friend, someone to nudge me along as I weave through a non-linear narrative. But when you’re changing oil, you can’t begin at the end, jump to the start, and then fill in the middle details. It’s a linear task with a clear beginning and end, and the workflow impacts the outcome. Changing the oil in a car isn’t life-or-death, but placing an order in an electronic health record (EHR) does impact the lives of patients.

For decades, healthcare has relied on Instructor-Led Training, or ILT, as its answer to education. More hours in the classroom equals a more informed and prepared workforce. It’s the same model supported by our nation’s education system. This would be fine, except that the learning outcomes are vastly different. Where a history class, for instance, aims to teach learners to know something, a hospital class aims to teach learners to know how to do something. Clinicians enrolled in a three-day training session must emerge with the ability to place a medication order using the EHR—a single task that may require upwards of 30 clicks on the computer.

Because actions in an EHR impact the lives of patients, an education model with hands-on, simulator-based training is better suited for teaching health professionals the proper use of an EHR. Perhaps this need is best described by Charles Fred, Group President of Xerox’s Healthcare Provider Solutions division. Mr. Fred is the founder and former CEO of The Breakaway Group, a company providing simulation based training to prominent healthcare organizations across the United States and internationally.

“Consider the value of teaching caregivers to use EHRs through role-based simulators,” he wrote in an article for the American Society of Training and Development. “Simulation provides an opportunity to practice in a real-life environment without real-life risks and consequences. Caregivers learn inside their actual EHR application, which is critical for learning workflow and gaining new knowledge about the system. They only learn tasks that are applicable to their role.” (Source: Fred, Charles. “Driving the Transition to Electronic Health Records.” Training + Development. American Society for Training & Development. Alexandria: 2012, Print.)

Simulation-based education solves many of ILT’s limitations. For starters, the simulations are based online and allow the learner, rather than the trainer, to perform the task. Providers and clinicians can learn to place an order by performing the task directly in a simulated EHR. They may do so at their leisure, from their computer at home, at work, or even at a local coffee shop if they prefer. As long as there’s an Internet connection, they may train until they’re proficient. Simulation-based training also saves money spent on the herculean effort to jam too many professionals into too few classrooms. Another benefit is that it’s more accessible. The simulations exist as long as they are needed and can be upgraded to reflect changes in workflows. Where ILT provides a training event, simulation-based education provides a sustainable solution for ensuring the EHR provides clinical value to the organization. Simulation-based education shortens the learning curve for healthcare providers and allows staff members to train more quickly so they can focus on their core responsibility – their patients.

A combination of simulation-based education followed by ILT can be used to achieve better results. The chief benefit of classroom training is that it provides a venue for social interaction and the exchange of ideas, but this is best leveraged when participants have confidence and knowledge in using an EHR. Simulation-based education makes this possible. After completing role-specific simulations, participants arrive to the classroom already proficient in using the EHR. They are engaged before class even begins. What could have been banter about the next break is now a meaningful conversation about best practices and ways to improve processes. Social interaction can now be leveraged to improve education. What’s more, because participants already have a foundation of knowledge and ability in the system, the training can now focus on teaching participants to complete more complex tasks and workflows. It can also devote more time to independent practice (the most conducive form of learning).

While healthcare’s focus on training hasn’t changed, the industry itself has experienced a whirlwind of evolution. Why then, amidst all the evolution, must providers and clinicians rely on an outdated education model?

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

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1 Comment

  • Good article. I’d add that it’s not just medical providers that need hands on during training; it’s anyone using or maintaining such systems, including anyone being trained to become a trainer.

    I’ve noted before how the ONC’s HealthIT training program was, in the end, nearly useless. A big part of that was that in a program that lasted several months (part time), it only included a couple of hours ‘playing’ with a single EHR system – VISTA CPRS. And that was mainly installing it and a quick look at each main component (like ordering and receiving results for lab tests). It had no exposure to the most commonly used systems. It mainly prepared someone to have a light conversation on the topic.

    Whenever I’ve been ‘in’ a hospital or doctor’s office, I’ve questioned anyone and everyone I could what they thought of their system AND the training received. Nearly universally they had nowhere near enough viable training, little ‘adjustment’ and customization, little if no hands on until they were actually using the system. An exception – an ophthalmologist I know well was part of a group who contributed to the development and testing of a specialized EHR, and continues to work closely with the developers on improvements.

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