New York ACEP EPIC - November 2024 | New York ACEP | American College of Emergency Physicians (2024)

The Learning Challenge

It’s no exaggeration to say that how we learn in healthcare can be demoralizing. Imagine another intense day of clinical care. The miles on the commute home feel longer than usual. You sink into the couch and use that last ounce of decision-making ability to settle on leftovers for dinner.

That is, until you check your email and realize you have several overdue compliance requirements. Now online, you click from one video to the next, reviewing low-yield content that requires just enough of your attention so you can answer the final quiz and get your credit for CME.

This scene plays out daily in clinicians’ lives at a time when how we learn has never been more critical. In a healthcare system undergoing rapid transformation and disruptive change, learning often becomes another checkbox requirement rather than what it could be – an antidote to complexity and burnout.

Our work in MedEd innovation shows that focusing on how we learn, not just what we learn, can be an effective way to address this problem. By creating better methods of delivering knowledge and skills, we can help clinicians be more adaptable and resilient and assist them in navigating complexity. We can address burnout by using education design to reconnect us with the heart of our profession. Great learning reminds us that what we do matters, connects us with our colleagues and patients, and inspires us to continue the journey of lifelong improvement.

Medical educators can lead this transformation by becoming design thinkers and innovators. They can create the next generation of learning systems that “meet us where we live,” integrate seamlessly into our workflow, merge digital and physical space to enhance our learning environment and make education more collaborative and engaging.

If what we learn is the fuel that powers our clinical judgment, how we deliver that learning is the pipeline through which that fuel flows. How well we build that pipeline will determine how effectively new ideas, knowledge, skills and technology flow to the bedside. This has consequences for both patient care and the well-being of the caregivers providing that care.

Our Work

Our education team at Weill Cornell Medicine took a collaborative design thinking approach to teaching high-quality airway management skills relevant to learners at all levels of experience, from medical students to experienced clinicians. We connected experts and physician educators with a diverse group of creative partners and deliberately searched for inspiration from outside traditional medical education sources to produce an innovative learning format to teach complex concepts and procedure skills in airway management. The result of these efforts is the Protected Airway Collaborative.

We first evaluated the strengths and weaknesses of current airway training methodologies and identified a core set of “built for humans” design principles. These principles focused on the learner and guided the development of our new learning delivery system.

Design Principles

• Focuses on how we learn
• Addresses human factors
• Applies adult learning theory
• Meets learners where they live
• Integrates seamlessly into the workflow
• Works for the environment in which it’s deployed
• Uses readily available “off the shelf” technology
• Merges digital and physical space
• Serves as a sandbox for further innovation
• Encourages collaboration
• Promotes diversity
• Seeks to inspire

The core team expanded its collaboration beyond the academic medical community by inviting artists, content creators, fabricators, graphic designers, storytellers and engineers to participate individually and through partnerships with educational institutions including the School of Visual Arts and Cornell Tech. This purposeful inclusion from outside the medical community provided skill sets currently unavailable within medical education and offered solutions arising from a diversity of perspectives.

Exhibits at New York City’s Museum of Modern Art (MoMA) served as our original design inspiration. MoMA’s exhibits create an immersive, interactive, self-directed learning experience through art, space, light, guided audio, graphic design and multimedia tools. This highly successful educational format engages millions of people every year with varied levels of subject matter expertise. We chose to model our educational framework after MoMA’s exhibits because of the numerous potential benefits of a more immersive and integrated teaching style.

Our design challenge was to leverage digital and physical space to recreate a museum-style experience in a low-cost and easily reproducible format using off-the-shelf technology.

The Digital Space

We evaluated multiple digital platforms for their ability to function as part of an immersive physical learning space. We developed an ecosystem of free digital tools, including Twitter, YouTube, Instagram and SoundCloud, to create a library of original content and a network of curated online resources. A low-cost website using WordPress (a user-friendly platform that allows medical educators with no web design experience) was used to organize this digital content into a theme-based curriculum similar to a series of online courses.

This online ecosystem stands independently as a valuable collection of educational resources. However, the intention was never to add to the crowded world of online courses or the growing number of social media “influencers” in medicine but to use these tools in a new way: through the seamless integration of digital content that is adapted to function in an immersive and interactive physical learning environment.

Our goal was to design education that operates both digitally and physically, enhancing the benefits of each.

The Bridge

The next challenge was creating a low-cost and reliable method of delivering this adapted digital content to learners in a physical space. We solved this digital/physical divide by applying graphic design principles to create a unique poster format as the basis for our immersive, interactive and exploratory museum-style experience.

Graphic design, as defined by the American Institute of Graphic Arts (AIGA), is “the art and practice of planning and projecting ideas and experiences with visual and textual content.” A ubiquitous feature of our daily lives, it is an overlooked and underutilized resource in medical education.

A well-designed poster is a workhorse of information delivery that captures attention, shares ideas and disseminates information. Until now, its use in medical education has been relegated to scientific poster presentations.

The interactive infographic posters prototyped for this project utilize the power of graphic design in several innovative ways: to deliver information, transform physical spaces and connect with multimedia content.

Each poster created for this project independently delivers important narratives, concepts, clinical pearls, memes, cognitive tools, practice-changing evidence or steps of clinical procedures. High-impact text and graphics are used to capture the eye, engage learners and draw them into the learning experience we developed.

Posters are grouped together in series. Each poster is an integral component of a layered theme-based narrative containing multiple voices and perspectives. In each series, various learning styles are incorporated to cover all the concepts and skills required to master a particular topic.

We applied graphic design principles to both transmit information in an engaging visual format and develop a “visual language” for the posters. This visual language provided a functional element to our immersive, interactive, museum-style learning space. Each poster in a thematic series uses color, a three-letter code and a numerical sequence that allows a series of posters to guide learners through the physical space created.

This graphic design-based schema originates from Massimo Vignelli’s iconic graphic design for the New York City transit system in the 1960s. Using color, circles, numbers and letters, his subway map transformed how people navigated the city’s subway system. Similarly, the poster prototype’s visual language guides learners through the physical learning space while still allowing them the freedom to travel within that space in any way that suits their learning objectives.

We embedded QR codes to connect learners with digital content. Upon snapping a QR code with their mobile device, learners see a digital copy of the poster, allowing them to feel and understand the connection between digital and physical space. An audio introduction recreates the museum tour experience and learners can then access all related multimedia content by scrolling down the web page.

These interactive infographic posters connect learners with relevant digital content within a physical space, allowing both to become more than the sum of their parts and creating the backbone of a learning experience that moves seamlessly between these previously divided domains.

The Physical Space

We grouped posters in theme-based series and utilized elements of simple pop-up exhibitions in defining our physical space, thereby solving a critical aspect of our design challenge. Our team focused on building an immersive, interactive, self-guided learning experience within this newly defined physical space. We focused on providing the hands-on training required to teach complex airway procedural skills in a format that existing digital content and online courses cannot deliver.

This required thinking about digital content creation with the physical environment in mind: integrating the digital content with laryngoscopes, airway trainers, fabricated models and other equipment to facilitate immersion into a sensory experience in which the digital space and physical space are complementary.

The Experience

These new learning spaces were designed to be self-directed, immersive and interactive. The theme-based interactive infographic posters are transportable and can thus transform any existing room into a museum-style experience.

Opportunities to develop core knowledge and skills occur in these spaces in a judgment-free zone. This allows learners to customize their learning, problem-solve and practice skills before receiving feedback. It encourages them to return to the self-directed portions of these spaces with more focused and refined learning objectives. The ability to rapidly cycle back and forth from coaches to self-directed portions of a learning space until mastery is achieved is a crucial design feature of the overall learning experience based on Kolb’s learning cycle.

A guide and point system gamifies the experience and functions as an assessment tool. After obtaining enough points, learners earn credit for completing the space. The assessment tool also allows the design team to see where learners are struggling and use this feedback for iterative improvements.

The Benefits

Traditionally, only online courses can run asynchronously. However, a major limitation of online courses is they cannot accommodate hands-on practice for procedure skills. Pop-up educational courses combining digital and physical content are different and can provide both asynchronous learning and hands-on experience. These courses are not limited by the time constraints of traditional courses and can be set up for days, weeks or even months to allow large numbers of learners to engage with the content and practice essential skills in pop-up spaces. The portability of the digital content and posters allows tremendous flexibility in the physical spaces that can be used. These spaces can include resident rooms, empty conference rooms or other common hospital spaces.

Our new learning model’s open-source and collaborative design complements other teaching approaches, including simulation. The flipped classroom element of our educational experience makes it ideal for integrating simulation as a capstone experience. Simulation cases are used to solidify the bridge between the digital and physical spaces by incorporating learning objectives drawn from the learning spaces themselves.

Another feature of this new learning model is the inclusion of diverse perspectives and even participants’ voices within the larger theme-based narrative. Participants are invited to record de-identified stories about challenging airways on video or in writing. Stories are then shared via the course’s website and the poster QR codes at relevant stations. Storytelling helps participants reflect upon difficult learning experiences. Interacting with others’ stories helps normalize anxiety around difficult airways so that the learners can focus on skill-building both during and after the course.

Our course design frees faculty from teaching in a one-size-fits-all format. The flipped classroom model enables learners to build confidence first before needing to demonstrate technique. As a result, an educator can work one-on-one with learners and tailor what they teach to a specific learner’s needs and skill level, making the process more enjoyable and efficient for both the educator and the learner.

Since the course’s backbone is a website designed to integrate digital and physical space, it is also infinitely scalable, allowing unlimited online and in-person learning. Through the printed posters, the website can run an endless number of our pop-up learning spaces across the globe without concern for geographic location or time. Remote coaching expands the potential of these new learning spaces, increasing the number of available educators and making the workflow for educators and learners more efficient. The course design also allows consistency to be built into the system. Providing a framework of instructional tools and materials means that many learners can be taught without significant variation or erosion in the quality of learning as the system grows.

We are particularly interested in evaluating this model as a low-cost teaching tool for healthcare systems in resource-limited communities. As most of the work is done on the front end with creation of digital content and posters for a physical pop-up space, the cost for others to implement the course is relatively low.

The collaborative and open framework of this course is fertile ground for further innovation. It provides a platform for studying and testing tools such as AI XR and attracts collaborations with fabricators, such as the Maker Lab at Cornell Tech, to design low-cost models that integrate into physical spaces. It also draws interest from illustrators, artists and content creators to develop engaging audio, video and graphic design features.

Next Steps

We have used this system to teach thousands of learners across our institution, the country, and internationally by deploying posters and equipment in break rooms, resident rooms, classrooms and other pop-up locations. From its inception as a small local project, it has morphed into a nationally and internationally recognized airway course.

A transformation in healthcare delivery can occur only if there is a similar transformation in learning delivery. We hope that our collaborative, low-cost approach, using available technology and existing resources, sparks further interest in medical education innovation, provides a roadmap for overcoming some of the barriers to learning in today’s healthcare environment and creates opportunities to develop new pathways toward viable solutions that inspire and teach physicians for generations to come.