How Do Healthcare Trainers Choose Learning Activities?

Once learning outcomes have been agreed, trainers and learning designers look for the best ways to achieve them. They select experiences that will cause the growth of the new mental connections required for competence. In healthcare training, we need all our learners to be competent. This approach is known as ‘mastery learning’, i.e. we need all learners to ‘master’ the skill. For this reason, we do not usually grade learners in work-based learning.

Resources to draw from

Trainers choose activities from a variety of sources. For example:

• Own memory: Recall the steps they took when learning the same topic.
• Recent learners: Ask those who have recently attended training in the subject what activities they found helpful.
• Other trainers: Ask other trainers which methods have worked best for them.
• Books and online resources: Explore approaches used by others.

Combining activities so they build towards the outcome

As we saw in Week 2, if learners attempt to process too much material at once, they can become mentally overloaded and unable to cope. So trainers divide learning into chunks. The diagram below shows a lesson divided into four chunks. The plateaus represent points at which feedback is provided to learners. This confirms achievement and motivates them for the next step. In this way their confidence builds alongside their ability. For each chunk, an activity is selected to provide the learner with an experience to build a new part of a mental model. To return to our analogy of buildings as mental models, we might say that each step completes another part of the building.

Example: Taking a manual Blood Pressure

A clinical trainer wishes to train Care Assistants how to take a manual blood pressure using a sphygmomanometer (commonly referred to as a ‘sphyg’) as shown below. The trainer creates a lesson plan that allows learners to develop the skill in chunks. These should be manageable but not too simple, to ensure the growth of strong mental connections. The trainer decides upon these activities:

• In groups, devise a way to remember the difference between diastolic and systolic. Also the significance of high and low readings.
• Identify the component parts of an aneroid sphygmomanometer and demonstrate how to apply, inflate and deflate.
• Listen to recordings of Korotkoff sounds. Then identify these sounds in each other using a stethoscope and sphyg.
• Record blood pressures of other learners, explaining their actions as they would with a real patient.

The definitions and names included in the first two steps are required to complete the third step. Similarly, everyone in the group will need to be able to identify Korotkoff sounds, otherwise they will be unable to complete the fourth step. This is an example of mastery learning. The trainer will ensure that everyone has completed each chunk before moving on. Otherwise, there is a risk that some learners will not fully absorb the following step and fall behind.

Starter activities

The way in which a training session begins ensures learners know what they will be doing and why. ‘Icebreakers’ are interactive experiences undertaken at the start of a training event. Their purpose is to ‘warm up’ the group and provide an opportunity to get to know each other. An icebreaker should be relevant to the training topic, so the trainer can use it to lead into the day’s activities. For example, on an Induction course for new starters, a trainer might ask participants to share with those sitting near them why they first decided to work in healthcare. Although the trainer cannot predict what they will say, some new starters are likely to have been inspired to join by a positive healthcare experience. Afterwards, some of these responses can be woven into a whole group discussion about how healthcare experiences are often remembered for many years.

Demonstration followed by practice

A demonstration is a commonly used part of training. On its own, its use is limited; watching your favourite guitarist play at a concert is not enough for you to be able to play! Instead, a guitar teacher will demonstrate a chord, and then ask you to play it. They will give feedback, then ask you to play it again. This basic principle of demonstration followed by practice can be applied to most practical skills. Learners watch a demonstration accompanied by an explanation. They then try for themselves and receive feedback. They have another go, this time incorporating the advice received from the first attempt. This may sound obvious, but it is surprising how often a demonstration is given without an opportunity for practice. Without practice, the shoots of new mental connections that start to grow during a demonstration are left to wither away. In the image below, a moving and handling trainer demonstrates how to operate a patient hoist. Learners then operate the hoist themselves. They practice placing a person in the hoist, and also experience being lifted themselves. If one of the group has the sling applied in a way that causes pain, he is likely to build an extra section of his mental model which will ensure he never does the same thing with a real patient. Learning by experiencing pain is not a teaching method we would promote! How would you ensure learners applied a hoist sling with consideration for sensitive parts of a patient’s body? One way a trainer might achieve this is to tell a story about a patient who was hurt in such a way. If she tells the story well, the learners will picture the incident in their imagination, and it will form part of their mental model.

Practice should be purposeful

An old saying advises ‘Practice makes perfect’. However, improvement is not guaranteed by repetition alone. Have you ever ridden in a bus or taxi that was badly driven? The driver had probably driven many thousands of miles. But repeating the skill many times over did not improve his driving. For practice to be effective, it needs to be based on feedback and undertaken with that guidance in mind. The taxi driver probably doesn’t realise he applies the brakes uncomfortably hard, because no-one has ever told him.

Group learning activities

A tried and tested learning activity is small group work. There are many possibilities which can be tailored to support the required learning outcome. The group may be given a problem to solve, a topic to discuss, or a creative task of some kind. The trainer ensures they keep on track during the activity by providing encouragement and offering suggestions if they appear to be stuck. Small group activities often end by sharing the results with the whole group.

Simulation; doing it for (almost) real.

The creation of a realistic environment in which learners can practice and receive feedback is known as ‘Simulation’. It is particularly valuable if the skill may need to be applied in conditions of stress. Although the term ‘Simulation’ is used to describe learning with sophisticated manikins, it applies equally to any situation where a learning experience is arranged to be close to real life. For example, a simulation may involve interaction with actors presenting as patients. In the image below, professional Child Protection trainers play the roles of a husband and his injured wife. Their behaviour raises concern about the care of their absent baby. A particular advantage offered by simulated situations is that other participants benefit from observing their fellow learner’s performance. The observers also learn from these witnessed successes and mistakes. They observe, form an assessment of what has happened and give their own feedback at the end of the simulation. This is known as ‘peer feedback’.

Learning activities in socially distanced times

Practical skills training is not easy to provide safely when social distancing and PPE are required. Risk assessments should be made which take into account the need for competence to be observed.