By Marcia Jackson, PhD, FACEHP
This article addresses the following Alliance National Learning Competencies:
Competency 2: Designing Educational Interventions
Implement and improve independent, fair, balanced, and evidence-based educational interventions that produce expected results for learners and the organizations in which they work.
Implement CE activities/interventions to address healthcare professionals’ practice gaps and underlying learning needs.
Develop CEhp activities/interventions with content that is valid and independent from the influence of commercial interests, balanced and evidence-based.
Educational interventions designed for healthcare professionals all too often begin with these two questions: “What content should we include?” and “Who should be the faculty?” These are important questions to answer, but starting with these at the outset of planning exemplifies the Yogi Berra quote: “You’ve got to be very careful if you don’t know where you’re going, because you might not get there.”
Planning educational interventions should be purposeful, and the most effective way to accomplish this is through a systematic method of instructional design (ID). A number of ID models may be found in the literature, but one often used is the “ADDIE” model. The acronym is derived from the initial letter in each phase of the model: (1) Analyze, (2) Design, (3) Develop, (4) Implement, and (5) Evaluate.
Designing instruction following the ADDIE model is analogous to the process of designing a home with an architect. The architect meets with the client at the outset to learn the type, size, and layout of the home that is being envisioned; the amount of money available and timeline for building the home; and other features critical to the home design. The architect analyzes the client’s needs, wishes, and resources to inform the design of the home. When this phase is completed, the architect develops a blueprint for the home and reviews this with the client. When all agree on the home design, development decisions are made: exterior and interior finishes and color, appliances, cabinets, lighting — the list probably seems endless to the client, but are essential when home construction begins. Contractors break ground, implement the design, and build the home. The attentive client evaluates the building process as it is occurring, as well as immediately after moving in and throughout the years of home ownership. This process, although it is presented as a linear model, is fluid in the sense that, although one typically moves through the design in these phases, back and forth movement occurs throughout the process.
A particularly useful feature of the ADDIE model for educational interventions in the healthcare field is that it generally parallels the competencies encompassed within the Alliance’s Competency Area 2: Designing Educational Interventions. Educational interventions for healthcare professionals are intended to be learning activities that close clinical practice gaps and thereby improve patient care.
The starting point for the analysis phase is to identify data sources that reveal practice gaps so that interventions can be designed with the end in mind. Data sources could include data registries, Medicare data, expert opinions, quality data collected within healthcare systems, literature reviews, and/or learner self-assessment. The consolidation of data from these sources and others helps pinpoint the practice gap or gaps. Not every clinical gap reflects a learning need. Gaps in appropriate clinical care may be the result of many variables such as patient adherence, insurance, or resource availability. Education planners must isolate the data that represent learning needs with respect to knowledge, skill, and/or attitude so that these needs may be addressed through an educational intervention.
Learning needs represent another type of gap: the gap between what a learner should know, do, or feel, and what is the actual case. The increasing emphasis in the healthcare professions on delineating essential competencies creates the standard for this gap measurement, and evaluation tools designed to assess these learner competencies provide the other end of the measurement scale.
Other information that must be acquired during this first phase of instructional design includes the following:
- Resources that are available to support the intervention, including funding, content expertise, and staff support.
- Delivery methods that are consistent with the intervention objectives, match the preferences of the intended target audience, and are feasible given organizational facilities and resources.
- Other organizations that may be addressing these same learner needs.
This list will be dependent upon the type of organization, the target audience of learners, the criticality of the clinical gap, and the nature of the educational intervention.
The data acquired during the analysis phase led directly to the development of specific learning objectives for the activity that can be stated as observable, measurable outcomes. This is the phase where the planner, typically working with a planning team that represents the audience(s) for whom the intervention is being designed, begins to design the specific intervention.
The design phase is perhaps the most important of the planning process, as it is during this period that key instructional decisions are made. When objectives are prepared, the evaluation tools to measure the attainment of these objectives should be specified. Delivery methods and format are determined. Content is agreed upon and appropriate experts to serve as faculty are identified. The sequence of content within the intervention is essential to the overall design. An important question to ask during this phase is: are we still keeping the end in mind? These design decisions should be led directly to the attainment of the learning objectives, which, in turn, support the reduction in the clinical care gap.
The design plan is launched in the development phase. A budget and management plan is prepared to guide the development and implementation phases. Funding is sought and obtained for the educational intervention. An evaluation plan is prepared and evaluation tools are identified or created. The experts who will be faculty must be recruited and agree to conform with the organizational standards with respect to presenting educational interventions that are fair, balanced, and evidence-based. If the intervention occurs as a live activity, facilities must be contracted and logistics confirmed. If the intervention occurs as an on-line activity, the delivery software must be designed and pilot-tested. Support materials — such as slides, cases, interactive exercises — must be designed and created. When all elements essential to the actual delivery of the educational intervention are in place, the next phase continues the ADDIE model.
The educational intervention now takes place, in accordance with the design plan.
Learner pre-testing or self-assessment may precede the intervention, and the learning outcomes may be measured through immediate post-intervention and longer-range evaluation in accord with the plan. As noted in the design stage, a primary question to be answered is: Were the objectives and the goal of reducing the clinical care gap met? Other facets of the educational intervention should be evaluated, including learner satisfaction with the activity and faculty satisfaction with the planning process and intervention delivery. If the intervention will be repeated in the future, the evaluation data should inform its improvement.
The continued use of a systematic approach using the ADDIE, or another instructional design model, becomes more integral to the planner over time. Most importantly, it provides a map to an endpoint that is where one intends to arrive.