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Mastering healthcare applications: Toronto hospital uses self-directed and computer-based training to meet clinical staff's learning needs.

Toronto's Mount Sinai Hospital, an internationally recognized 462-bed healthcare center affiliated with the University of Toronto, recognized that its increasingly busy clinical staff simply did not have the time or schedule flexibility to use traditional training methods to learn the escalating number of clinical applications required to best serve the hospital's patients. Mount Sinai firmly believes in leveraging the latest technology to better serve its patients, but felt that the steady growth in the number of clinical applications meant that the initial time required to learn new and upgraded technology was becoming increasingly invasive for its clinical staff. We wanted to find a better method of training that would allow clinical staff to spend less time mastering new applications and more time with patients.

As part of Mount Sinai's Informatics Technovision Unit, the systems education team and I were tasked with developing a training method that would not only enable physicians, residents, and nurses to expedite the application learning process without interfering with their busy schedules, but also ensure that clinical staff would be able to apply their knowledge in scenarios that accurately reflected real-world clinical situations. This would ensure competency and guarantee clinical staff could spend maximum time caring for patients. Also, as a teaching hospital, Mount Sinai wanted to minimize the time needed for clinical students to learn the hospital's existing clinical applications.

New Initiative With e-Learning

With a budget for the project established, the team began working together with in-house clinicians on a learning approach that was self-directed and computer-based. We felt that traditional classroom learning not only forced staff to commit to prescheduled classes, but also, since some students learn faster than others, instructors have to teach at a pace that is too fast for some students and too slow for others. A self-directed approach made it simple for clinical staff to study at a pace that best suited their learning curve, and at times that best fit their busy schedule.

We chose a blended learning approach that recognized that a classroom component was still necessary to allow clinical staff to apply what they learned, was tailored to their specific rotation, included a hands-on phase and that accurately reflected service and practice at the hospital. As this classroom-scenarios phase would only take place once learners felt confident that they had mastered an application, it would enable learners to book a time that best fit their schedule.

The result of Mount Sinai's six months of research and development is Sinai e-Learning, a new initiative that divides training into two distinct competency-based phases.

Taken in Phases

Phase One involves self-directed computer-based learning, via a CD or the Web, which makes it simple for clinicians to study from any available computer at times that fit their increasingly-busy schedules. Utilizing off-the-shelf tools, Sinai e-Learning enables clinicians to simply insert a CD, or access the intranet, and then click on their designation and the appropriate chapter to begin training. To increase retention, each chapter demonstrates the functionality of the application being learned and the benefits to the user via a combination of visual cues and a clinician's voiceover. An interactive practice session is available at the end of each chapter. Once completed, clinicians take a final self-assessment and the results are displayed.

Sinai e-Learning may take some learners two hours to complete, while more computer-savvy learners may only need 15 to 20 minutes. Learners decide if they need to spend a couple of hours reviewing each chapter thoroughly and completing each interactive practice or if they can simply skim the chapter and quickly complete the competency based self-assessment at the end of Phase One that signals that they are ready for Phase Two. Computer-based training also guarantees that instruction is standardized, ensuring that all clinical staff learn the same methodology.

Phase Two only takes place once learners are confident they are ready for a hands-on session with a qualified instructor present to answer any questions. After completing the self-assessment in the first phase, learners book a convenient time in Mount Sinai Hospital's computer laboratory and follow a scenario tailored to their specific rotation. Once learners are confident of their competency, they are tested to ensure that they have successfully mastered the particular clinical application. A user must score higher than 80 percent in the test to be allowed to use the application on the hospital floor.

It is this second phase of training that makes Sinai e-Learning different than the traditional computer-based training. This is where the clinicians can interact with their peers and exchange knowledge as they work through scenarios that accurately reflect their practice. This ensures that clinicians feel absolutely comfortable when first using a new application in the hospital, having accurately mimicked their work experience in the lab.

Once developed, Sinai e-Learning was piloted with groups of physicians, nurses and allied professions in January 2004. Pre- and post-assessments measured the ease of use and acceptance of the tool, and determined knowledge retention. Of 186 clinicians surveyed, 96 percent said that the Phase One self-directed e-learning was both simple to understand and easy to navigate. As the table illustrates, Sinai e-Learning also received high praise from 260 clinicians who were asked to rank various aspects of the tool on a five-point scale, where five equaled "strongly agree" and one equaled "strongly disagree."

Finally, the team undertook knowledge assessments to ensure that Sinai e-Learning not only expedited learning but also ensured competency. Retention of learned material was found to be the same or better with Sinai e-Learning in every instance, with well over 90 percent of learners scoring above 80 percent on the initial self assessment. This feedback underscored the fact that Sinai e-Learning met its goal of making it simpler for clinicians to master new clinical applications. The significant benefits of this new e-learning tool have already garnered significant interest from several clinical facilities throughout North America.

Beyond the Pilot

With 842 clinicians already trained on the new system since July 2004, the pilot has been so successful that Sinai e-Learning has become the standard method of training clinicians on new applications at Mount Sinai. Sinai e-Learning will now be used for training on electronic clinical documentation, electronic medication administration and computerized physician order entry. Additionally, agreements have been formed with clinical schools to have students complete Phase One training before beginning their rotation at the hospital to ensure clinical students are already up to speed on Mount Sinai's existing computer applications.

By expediting the learning cycle for Mount Sinai's 1,000 clinician trainees, 700 physicians and 1,200 nurses, Sinai e-Learning has not only allowed clinical staff to spend less time in classrooms and more time with patients, but also has enabled Mount Sinai Hospital to reduce classroom and instructor time--enabling the hospital to free up additional budget to be spent on other aspects of patient care.

Sinai e-Learning enables busy clinical staff to combine the best of computer-based learning with the best of instructor-based training. Through Sinai e-Learning, it is simple for clinicians to get up to speed with new and upgraded applications, and test their knowledge in scenarios that accurately reflect real-world clinical situations--accelerating training, ensuring competency, and guaranteeing clinical staff can spend the maximum time caring for patients.
 On a scale of
User Evaluation of Sinai e-Learning Results 1 to 5

I feel confident using the application with minimal
assistance 4

The session helped me understand how this
application would support patient care 4

The practice lessons helped me to better understand
how to use the system 4

The trainer was responsive to my needs/questions 4.5

The environment was conducive to my learning
needs/questions 4.5

I feel there is enough support materials to help me
when I leave the class 4

The learning objectives were covered for each chapter 4


Marilyn Sanli is manager of information systems and education at Mount Sinai Hospital in Toronto. Contact her at msanli@mtsinai.on.ca
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Title Annotation:e-Learning: Case History
Author:Sanli, Marilyn
Publication:Health Management Technology
Geographic Code:1USA
Date:May 1, 2005
Words:1321
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