Tag Archive: cme

Questioning strategies in Healthcare Training develop critical thinking, decision making, and problem solving in students. Bloom’s taxonomy of the six levels of cognitive learning can be used to provide a framework for creating questions. Bloom’s taxonomy starts from the simplest level of learning to the most complex level.  Simplest levels denote Knowledge and Complex levels denote Evaluation.

Sample Question for Knowledge Test:

Intravenous Urogram

Knowledge Test

Asking a learner to define Intravenous Urogram, (IVU) would test his/her knowledge levels.

Sample Question for Evaluation:

Intravenous Urogram

Complex Evaluation

A question is posed to the learner to  assess a request to perform an IVU on a patient allergic to iodine. Experiential activities/ simulations can be built to guide the learner in decision making. In this case, the learner gets to immerse in a simulated scenario, evaluate patient vitals, reports and assess the conditions under which an Iodine-allergic patient can be subjected to Intravenous Urogram.


A baccalaureate nursing program study determined what proportion of terminal objectives for clinical nursing courses are high level objectives (analysis, synthesis, evaluation), and are the kinds of questions asked by teachers and students during clinical conferences of a high level also.  Despite the fact that stated objectives specified higher cognitive-level thinking, lower-level questions comprised 98.94% of the total number of questions asked by teachers and students in the clinical conferences surveyed.

Another study was performed within an Australian nursing program to examine clinical teachers’ use of questioning strategies.   The teachers’ years of classroom and clinical teaching experience, years of clinical experience, and academic qualifications were studied to see if an association between various qualifications and levels of questions existed.  Bloom’s taxonomy of the cognitive domain was used as a framework for the study.  The findings revealed clinical teachers asked more low-level questions (91.2%) than high-level questions (4.4%).

Lower level questioning do not promote critical thinking as they only trigger recall of information in the learner’s mind.  A simple recall of information does not enhance students’ understanding of the information in a meaningful way. Higher level questioning facilitates the development of critical thinking because it is aimed at higher cognitive levels, which involves application, analysis, synthesis and evaluation.   Educators should take advantage of stimulating questions more often to help create meaningful active learning instead of just prompting the simple recall of knowledge from students.

Scenario- based learning stages a context, within which learners live and work in their everyday life. It’s based on the concept of situated cognition, which is the idea that knowledge can not be developed and fully understood independent of its context(Randall 2002). Scenario-based learning puts the student in a situation or context and exposes them to issues, challenges and dilemmas and asks them to apply knowledge and practice skills relevant to the situation (www.ucl.ac.uk).

Scenario- based learning has particular advantages for practice- based discipline areas where the experience of practitioners is especially relevant to what constitutes knowledge and understanding in the field. Using scenario-based learning in the field of Healthcare has brought forward many such advantages to learners that count on practical experience in everyday activities.

Let us consider a case where Indira Gandhi National Open University conducted such a scenario-based learning project. 10 academic programs were chosen to be included into this project.

The following frame work was given to develop the scenarios:
1. Define critical competencies for graduates of the program
2. Identify learning outcomes for students in the program
3. Identify learning context and develop suitable learning scenarios that reflect the events in life and work of persons who have acquired these competencies
4. Define learning activities assessable and non assessable tasks.
5. Identify all learning resources and instructional opportunities
6. Identify and define cooperative and collaborative learning opportunities using technologies.
7. Identification and definition of opportunities for feedback and remediation.

Let us study a sample scenario as an example:

Discipline: Civil Engineering

Topic: Structural Analysis

Learning Objectives:

1) To distinguish between static and dynamic loads
2) To conceptualize the influence lines
3) To differentiate between Influence Line Diagram (ILD) and Bending Moment Diagram (BMD)


It was a shining morning of October. All students of your class are in cheerful mood traveling to Roorkee in Jan- Shatabdi Express for educational trip with Prof. Dutta.
Suddenly, you feel a shock as train stops abruptly. While waiting for the train to re- start, it is leant that due to some accident on the bridge ahead, the train will not move at least for next 5 hrs.
Out of curiosity you all move to the accident site with Prof Datta. You observe that there is a lot of distortion of the track and even the rails have gone out of place. While discussing the reasons of track failure, Amit points out the presence of visible cracks in the side beam
of the bridge. Suresh asks Prof. Datta whether the bridge failure is due to excess loading.

In turn, Prof. Datta asks the students, whether they remember different types of loading on the structures. You all start naming the different types of loading, you have seen earlier.

Learning Activity 1:

a) List out the different types of loading on structures.
b) Categorize the above list into static and dynamic loads.

After going through the list, Prof. Dutta asks you that why the live loads are not considered as dynamic load when the movement of goods and human beings are considered in the live load.

Learning Activity 2:

Identify the characteristics of static loads and dynamic loads.

Prof. Datta asks the learners to tie a rope across two poles tightly. He then asks Suresh to hang four bricks at four different places and observe the deflected shape of the rope.

Simulation 1: Prof Datta asks you to remove the three bricks from the rope starting from the right pole and observe the deflection of rope at mid point.

simulation activity

Simulation 2: The he asks to repeat the same exercise by moving the brick at points B, C , D and E subsequently and observe the deflection at mid point each time.

simulation activity

Conclusion: The whole scenario-based learning program was developed to be very challenging and was able to completely immerse the learners into the learning cycle.


Roll back to 1985, when Chip Morningstar and Joseph Romero in designing LucasFilm’s multi-palyer online game Habitat.  This is when the word ‘Avatar’ was coined in its then context. Since then Avatars, Actors and Characters have some terms that describe the virtual representation of the player or user in varied contexts.

In the recent years, a stigma of focused effort has been constituted to establish a social context between the learner and the learning platform (be it any form of learning content).

In simple and practical terms, a Character or Avatar creates a social representation of a real person into a designated role within the learning program. Relating this to the current Healthcare Learning and Educational landscape, the involved persons are majorly Physicians, Students, Clinicians, Academicians and other allied healthcare professionals. Each individual applies to its specific competency role in the industry.

As we speak about the industry specific title, each title is entitled to a role which performs its designated role in a Practice-Based environment. A Practice-Based environment demands only and only Practice in Practical.

The challenge here is how does e-Learning transform learning to be virtual yet practical. How can e-Learning in it’s inorganic matter deliver results similar to that of organic and practical methods.

Avatars play the bridging role here. An Avatar can play various social roles.

Expert/ Instructor/ Coach: Here the character is modeled after an expert or knowledgeable human – most commonly a senior surgeon, professor, training manager/head or expert in the field such as a regulation,etc. Effective use of this role with the help of an Avatar ensures social engagement between the character (Avatar) and the student through a conversational tone, interaction, and feedback.

Learner/ User: An Avatar of learning establishes the emotional presence of the learner into the learning scenario. It simulates the learner’s belongingness within the learning context and situation. An Avatar created with situational and curriculum based contextual engagement allows the emotive mind of the learner to dwell into imaginative and experiential learning.

C0-learners or Peers: Avatars of co-learners or learning buddies create a sense of being accompanied. It helps eliminate the loneness factor of the learner and builds a scope of togetherness into the learning environment.

Immersive e-learning

In the study, We Learn Better Together: Enhancing e-Learning with Emotional Characters (2005) by Heidi Maldonado et al., it is discovered that the presence of a Co-learner resulted in learners performing better. Students with a Co-learner scored significantly higher than students without a Co-learner.

There are experts and then there are instructional experts who have brought a huge value by proposing various best-practice instructional approaches to aid web-based science education and training. All such instructional theorems and hypothesis contribute to the foundation grid lines of online training and education.

While physical models and virtual 3 D models deciphers a great value for teaching Fundamentals of Electrons in Atoms and Molecules; the greater need has always been to empower students to read, research and discover underlying facts of such subjects.

Leveraging from emerging e-learning technologies and tools, e-learning inventors have produced innovative and immersive discovery tools that cater to the above said need.  Leading educators like Wiley, Elsevier and other scientific innovators have transformed model-based training methods to discovery-based simulation applets.

A Case Example:

To teach the Motion of  a Projectile, a simulation can be created as an applet. The “Reset” button brings the projectile to its initial position. You can start or stop and continue the simulation with the other button. If you choose the option “Slow motion”, the movement will be ten times slower. You can vary (within certain limits) the values of initial height, initial speed, angle of inclination, mass and gravitational acceleration. Below is an example of similar instruction as created at Walter Fendt.

Another interesting example can be seen at Glovico.org. Glovico provides a social business platform to learn and teach languages. Teachers are native language experts who decide their coaching prices. Students get the liberty to choose teachers based on prices and ratings.

I remember learning about Set Theory and Venn Diagrams in the late 90’s by reading text books and practicing exercises on paper notebooks. I feel envious of what technology has brought to today’s mathematics students. Utah State University has been creating interactive mathematics exercises that allow Discovery-Based learning for student. Using applet-based intuitive functions and guided instruction, students can explore and attempt randomized mathematical problems.

It is heartening to see technology and learning instructions blending into exploratory tools that encourage and empower learners to adopt online learning and training through a Scientific-Discovery based instructional approach. For all ages to come, I firmly believe, in way or other, this would be the best instructional approach to any subject of training, majorly for science education and training.

Healthcare institutions spend enormous time and effort to train their workforce. Web-based training can streamline this process to a great extent. The article evaluates the advantages of healthcare professionals with web-based training.

Large healthcare facilities are required to educate their workforce about various regulations and to document this training. Initiatives like the Privacy Rule of the Health Information Portability and Accountability Act (HIPAA) and the National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are just two recent examples. In addition, health care professionals require training on equipment, skills and software. Using traditional methods such as instructor- led classes to train a large and diverse workforce is time consuming, expensive and labor-intensive. Webbased training can potentially overcome these limitations.

Web-based training provides learners with any-time access to the training courses, is self-paced, eliminates the need to travel, is less disruptive for the work schedule, and can decrease the time associated with learning by as much as o 30%. Moreover, it can substantially save time for the faculty and instructors since web-based training can be developed once and delivered multiple times across various locations. Published studies evaluating web-based education and training have shown that web-based education is at least as effective as traditional education, that it is likely to be more efficient and that learners enjoy it more. These advantages make web-based training a very attractive option for training healthcare personnel efficiently and effectively. Furthermore, many hospitals and clinics are upgrading their information technology infrastructure as they increasingly adopt electronic health records. This infrastructure can also support the utilization of web-based training.

Training healthcare professionals is not an easy task due to inherent characteristics such as shift work, moderate to high employee turnover, and the difficulty in organizing group-training sessions due to conflicts with clinical responsibilities . Web-based training can be deployed for healthcare workforce spread over different geographic areas, without compromising learner satisfaction. At InfoPro, we developed a comprehensive suite of web-based courses on various therapeutic areas. These courses were developed using print based medical literature and presenation kits used in medical symposiums as reference curriculum materials. Our client was able to train about 18,000 professionals, including physicians, researchers, pharmacists, nurses, nutritionists and trainees in these fields, across different hospital systems within a short span of two months. Satisfaction ration was over three-quarters of the attendants. Learners were very satisfied with web-based training and most of them felt that the course was relevant and helpful for enhancing their understanding of the subject.

In addition to time savings and enhanced 24-hour access to courses, web-based training can also yield a good return on investment (ROI).

Studies suggest that web-based training can reduce up to 70% of employers’ training budgets by eliminating employee travel from offsite locations, cost of updating printed materials, and reducing the amount of time that employees spend overall in the training activity.

Moreover, as institutions increasingly adopt electronic health records, they will need to upgrade their hardware infrastructure, which will also support the deployment of web-based training without incurring significant overhead cost. Thus, we believe that well-designed web-based training can yield an excellent ROI for healthcare systems challenged with perennial workforce training and the need for increased documentation for regulatory compliance.