Amanda Kaczerski, ATC, MS, CHCP is Vice Principal of Educational Strategy at the Academy for Continued Healthcare Learning. We first met at the beginning of 2020, feels like 100 years ago now, when we both co-presented as faculty in a prep course for the Alliance's CHCP exam. I'm delighted to have her on the show today, we're going to talk about instructional design, and geek out a little bit and some of those instructional design parameters.
00:04:19 From field sales to learning design
00:06:11 Pay attention to clinician goals
00:11:00 Dealing with online fatigue
00:27:15 Key Take Aways
Alexandra Howson 00:01
Hello, and welcome to Write Medicine. I'm here today with Amanda Kaczerski, ATC, MS, CHCP Vice Principal of Educational Strategy at the Academy for Continued Healthcare Learning. I'm excited to talk to Amanda. We first met at the beginning of 2020, feels like 100 years ago now, when we both co-presented as faculty in a prep course for the Alliance's CHCP exam. I'm delighted to have her on the show today, we're going to talk about instructional design, and geek out a little bit and some of those instructional design parameters. So let's dive in. Can we start first of all just by talking about how you find your way into maybe education in general, and CME in particular?
First, let me just say thank you, for inviting me and including me in this podcast, I'm delighted to have this little chat with you. I think my way into CME is a lot like a lot of other folks in our industry. We just fell into it, I was in a prior position, working in the occupational medicine field, and just was ready for a change. And I happen to stumble across this job posting that was relatively close to my house. And yeah, this sounds interesting. You're educating physicians and working with pharmaceutical companies, I live on the East Coast, I'm surrounded by pharmaceutical companies. To me, I was like, oh, let's see what this is about. And I had a wonderful just interview with the president of that company, and we seemed to hit off right from the get go. And basically, it just kind of was like, okay, you're you have a good rapport about you, you seem like you have a good head on your shoulders. And this is going to be Baptism by fire. So let's go. So when I started, it was, I want to say 2008. And it was really at that time a period of CME where things were changing. And where I think I was able to jump in was that I didn't have I don't want to say the baggage, but I didn't have the experience of my predecessors who remembered the wild wild west where, you know, times were loosen free, and you could, you know, basically have any kind of conversation you want, and really just kind of put a number on a paper, and that would be your, your grant. So I came in already with parameters and just, you know, a new world of seeming that basically started my foundation. And I think that, that allowed me to really get into the whys. You know, why are we doing this? How come CME is working. And that is really what started my path in CME. And my interest in instructional design,
Alexandra Howson 03:09
There's something really powerful about being on the edges of things and being able to have a different perspective about what's going on in the center. And ask those sometimes difficult questions, or the questions that other people haven't necessarily been invested in or thought to ask. I'm curious, you said you're in occupational medicine. Did you have a kind of learning design role there?
No, actually, not at all I was in I was in the field, I was a Field Sales and regional manager type of position. My, my background, my schooling and clinical background is as athletic trainer, so I did work as a athletic trainer at a division one university, and then also in the high school. So clinically, I youknow, have a foundation of science, medicine. All of that part of it, which is really one of the reasons why I gravitated towards me because I felt like as a healthcare provider myself, I know what it's like to have to take CME courses. And, you know, it brings a lot of perspective to me when it's my turn to go and take my course and I know what I like and I know what I don't like, when I actually want to sit down and learn and when I just want to get credit.
Alexandra Howson 04:35
Yeah, that's, that's really interesting. You have that healthcare provider background, but you also have that, you know, learning and education background in terms of training. How do you see differences then? Sometimes people use those terms interchangeably, right? Training, learning, mentoring, educating, do you have kind of working, you know, differences in those kind of concepts in your day to day?
Yes and No, I don't think I ever honestly really thought about it until you just mentioned it, you know what I take a step back and breathe, revisit your question. I want to say no, you know, it's not different. However, how I do it? Yes, it's, it's very different, you know, and I don't, again, realize why I wouldn't even say that. Because I do think that what we do for clinicians in our CME courses, really is exactly the same thing that we should be doing internally and for anything that we're doing education, learning training wise it is, especially for those of us who are in the adult education space, we are always learning improving or training for a reason. So, yeah, now that you've brought it to light, I don't really see a difference.
Alexandra Howson 06:02
The kind of key hinge linchpin there, I guess, is goal and intention. Mm hmm.
Yeah, no, I think it really does. Dive really what you're going to do as a, as an individual, in our workplace, you know, what is the goal? As a clinician? What is your goal? And that is really what's going to determine the steps that you're taking is being either a quick sprint or a slow crawl?
Alexandra Howson 06:39
The athlete coming out of there, right? Do you think we pay enough attention to goals and clinicians on goals in the education that we design and provide and CME?
Unfortunately, no, I don't think so. I think we so often are just focused on getting them to the content, getting to the activity that we don't always stop and think, what is the clinician looking for, in this activity? What is their goal? What are their goals? And it makes me think more so now, as the outcome standardization project (OSP) has really been underway. And for the longest time, there's been a lot of focus on the number of CME certificates and completers. And these, these terms that still are very variable, but the OSP has new terminology that basically said, it doesn't matter if they claim credit, if they came to the activity with the intention of looking for one certain segment or one piece of information, and they got it, then learning occurred. And, and I think it's really, potentially the cusp of us really trying to think about that more, why are we creating the education? For whom? And is it okay, if we, you know, don't have them all completing the credit, and, you know, earning CME, and they are just getting the content that they need. So I think, historically, it definitely has been looked over. I know, I, more often than not, I'm always trying to be that voice of, well, I think you're looking at it from, you know, too much of an ivory tower, let's take a step back, and how would a user go through this activity? What is a clinician, you know, trying to get?
Alexandra Howson 08:38
So that's really interesting. Have you been involved in the OSP project?
I have not been, I've been following it, you know, from there first, I guess release of that first was a white paper a year or so ago. And I know that they've been really talking about it quite a bit. I know a lot of the supporters now that there's a number of supporters now that are starting to adopt the definitions. And I think it helps us as providers, just know what they're looking to see and what these terms mean to them. And I think that the big piece, and I've heard it discussed at various meetings, is that it's not for us to define the value of what those definitions are. So some supporters will put more value on a different, you know, definition than what I would consider a valuable number. But that's not for me to determine. It's for me to say, you know, across the board, when I'm giving you this learner number, this is my definition, and this is what's acceptable or what's been recognized in the industry.
Alexandra Howson 09:47
That's interesting. And listeners, if you're not familiar with the OSP, it's the Outcome Standardization Project, which was initiated by a group of let's go call them methodologists; outcomes methodologists in the Alliance for Continuing Education in the Health Professions, and I'll make sure to put a link in the show notes to some information about that project. I guess talking about outcomes takes us to design and the whole notion of educational design. What are you thinking about? Or what's your starting place? When you are thinking about educational design and strategy?
I'm always thinking about what we are trying to accomplish? Who are the audiences? And how are we going to design a program? So some of the first thoughts I have are, well, is it going to be live? Or is it going to be a web based program? Yeah, 2020 seems to be the year that, you know, it has put a wrench in a lot of things. And all of us have gravitated, and just by force, really, to go into a web based space, which I think allows for a lot more creativity in some ways for instructional design. But I do think that it lives too, you know, when we're trying to determine, what are we going to create? It's for me, is it going to be a live or web based program? And then I take a step back and try to figure out, what are the gaps? What are the clinicians doing? Really look at the big picture of the needs and determine how are we going to change this as a knowledge change? Do they just need, you know, that knowledge type of approach? Or is it much more robust? And we need to get into that clinical and physical practice change?
Alexandra Howson 11:44
So a couple of things come to mind there. One is about differences between designing for knowledge versus designing for skill or competence. And the other is, you mentioned, you know, we and listeners, we are recording this in September 2020. So we've had six or seven months of mostly working from home if you're in the education field, and a lot of live meetings moved online. So my question is, are you seeing online fatigue in your learner's given that, you know, the whole field is pretty much locked into an online approach?
Yeah, you know, I think it's definitely more anecdotal. I don't have any solid evidence. And I think I've been talking to colleagues and our, what we have seen, at least one I've seen is that from, say, April through July, everything was just, you know, this, just push it out, we just got to push it in virtual. And some groups really did a wonderful job of transitioning a live in person, you know, annual meeting into a virtual event. And then there's others that really still need to try to figure out what are the best ways to do it, but at the end of the day, clinicians are, it's really going to ask a lot for a clinician to sit in front of a computer for eight hours, if that's your intention of delivering a virtual conference. So right, I think instructional design took on a whole new approach, when push came to shove this year, and groups had to figure out, how are we going to deliver this education that was delivered and originally intended to be a live two day event, and now we're going to push it out as a live web based activity. I think that there's a lot of considerations. Outside of that still, when it comes to online education and creating activities. But where clinicians in general are working still, they still had to go to do their jobs. So then you have to try to figure out, what are we doing with the activity? And how can we still have that meet their needs, in their very busy schedule? And it comes back to that question that has has always been present, since at least as long as I've been in the field of how are we going to reach the clinicians, you can create this wonderful activity, but if no one's coming, because the schedule isn't conducive to theirs, or after work. Now they have to manage their kids who are virtual learning and everyone's there. There really was a very, what I noticed that really small window of trying to push out a live web based program. And I think what we've seen and we've heard talked about more is that some of the tried and true classic print or text based activities that someone can print out Or at least access on their own without having to sign in and follow a live virtual Stream seems to be getting a little bit more attraction again, because it puts the onus back on the clinician to work when it's conducive to them.
Alexandra Howson 15:14
Yeah, that makes sense. Actually, I haven't heard anybody talking about that. But thinking about it in terms of people being zoomed out, it's not, you know, online programs are not necessarily always at convenient times for clinicians. So being able to have that you know, something in your hand that is
tangible, and that you can or your, your device that you can kind of pull out when you need to completely make sense. And so what are some of the things that you're doing and thinking about in trying to breach that, that zoom fatigue, because the other part of that is and you kind of alluded to is, it's always hard in instructional design to get somebody's attention. Jonathan Haidt talks about this in his book, “The Happiness Hypothesis”, where he describes the brain as a writer and an elephant. And on the one hand, you have the writer, that is the kind of rational decision making part of the brain. On the other hand, you have the elephant, which is our emotions and our gut feelings and all the others attracted to shiny objects, parts of who we are. So how are you thinking about that? And approaching that in this really interesting set of limitations that we have right now?
Yeah, yeah. No, I think I love that analogy. I think it's such a great question. Because when I, when I look at the online activities, and I was just, you know, talking about the live annual meetings and live virtual conferences that have taken one, one pack for online learning, online learning can go so many different directions. And I think I have always gravitated towards online courses and creating them just because of the flexibility and the ability to offer them on demand. So they're available for clinicians, regardless of if, you know, a live webinar or virtual conference. So I think that the instructional design is essential for online programming, because a clinician can start an activity and very quickly, if they're not engaged or seeing something that's meaningful or relevant to them, they can close the window and very easily find another program if they're looking for CME. So I do think that that shiny object syndrome is something that you kind of have to play with and CME, but make it meaningful. So I've always been a huge fan of the ability to create a course that's going to be relatable in some manner to the clinician. And does that mean? Is it just using some really powerful cases? Or is it using different means of engaging them getting a faculty who is a little bit more experienced or has the capacity to use more of a storytelling approach that's going to, you know, have them come in if it is more of a didactic lecture, or didactic type program? I think that with technology, the world is really at our fingertips. So a lot of the discussion over the past few years has focused on personalized learning. And I think, you know, we hear personalized learning quite a bit. But what does that really mean? Is it just a question and answer type of progression where they're getting content that's personalized, more? Is it really adaptive learning? Are we able to offer more adaptive learning? So these are terms that we within the industry use, and I don't know, if clinicians really would react to saying, oh, an adaptive learning platform, but I think it's using some more of those creative elements in your design and in your marketing that's going to draw them in. And that's kind of slightly disheartening, because you don't want to put so much effort into, you know, elements that at the end of the day aren't going to impact the practice or aren't going to improve one's knowledge, but you have to get them to your activity. So yeah, there's different pieces to the whole spectrum of learning and that first piece of pulling them in, you need the bells and the whistles and you need some of those shiny objects. But once they're in the program, I do think it's really important that we go back to there's foundational elements that have been shown to be effective for improving knowledge. You have to have interactivity. Is it gaming? Is it pulling questions? Allow feedback. Is it that live feedback from the presenter? Or is it a pre-recorded, you know, some sort of communication back to them, because there's been enough literature out there that we know, what you know, has been shown to be effective. And it's about time that we start applying those principles into the work that we do. And that's what I love. I love just looking into literature, seeing what's been shown to work and figuring out how we can do that in our program? And what is going to be overkill? And what is going to be just enough, right.
Alexandra Howson 20:50
Closing that loop through feedback and reflection is so important. And you've you've talked about instructional design a couple of times now, is that? Or do you think that we're seeing more explicit instructional design in medical education and education for health care professionals in general? and perhaps even five or six years ago, you've been in the field since 2008? Can you talk a little bit about some of the changes you're seeing in how people approach education design?
Yeah, I think for sure, I definitely say, within the past few years, I've seen it tremendously, without doubt in the work that we're creating. But then also, when I'm looking at other programs out there, I'm seeing it and then for my own personal continuing education, which is, to me, I always thought they were just on the back burner, you know, the courses that I was taking, and they actually sat through a course for my own personal, not even semi professional development, but my own athletic training development. This is wonderful. They're doing what we've been trying to do, you know, for physicians. So now, as definitely applying across the healthcare and education field. I think for a while, that was still the tried and true, a pretest and a post test. That's how you're going to measure, you know, that's how you're going to measure change. And you're going to have a didactic lecture, that that's how it works. That's how clinicians have been trained. And that's what clinicians want to see. And some questions still do. There's nothing wrong with that. But I think we know that there's different ways to get that done. So it's been a slow transition, even live symposia have figured out ways to have it be more than just a didactic lecture. And again, like you said, I've been in this field for 12 years, and I've seen it. I'm excited to see where it's going to continue to go again. I keep coming back to technology, but I think technology is playing a huge role in that. Right? In they I've seen it more in even the live symposia sessions, where now they're weaving technology in it and different ways to make it engaging with the 3d animations and graphics, you know, through presentations, or is it the ability to incorporate some of the iPad technology and have the learners access information and, you know, studies on their phone and follow along on their own personal devices. So it's ways like that, that one's turned a huge symposium into just a one way lecture to now an opportunity for the audience to to be engaged again. And it all comes back to engaging that clinician to drive them through the program and help them get at least, you know, one clinical pearls out of the content.
Alexandra Howson 23:56
Oh, it's so interesting, what you say about technology, because it's, it's kind of shifted from. It's not just this adjunct to learning and education, you know, our whole lives are integrated with and woven through and around technology. You know, we're kind of connected in all sorts of different ways. So it'll be interesting to see how that evolves. And also, you know, you kind of make the point that you're, you're doing training in your, in your athletic field, I think, Well, here's a question. You know, to what extent do you think continuing medical education is going to be cross fertilizing much more with the kind of online training that we are seeing exploding in just about every field at the moment?
I think it's going to continue and I think that, you know, we've been charged or maybe we've been a little slow at looking at what other industries are doing, and I think we're slowly adopting it ourselves. So I do think that training, you know, like you're referring to it has been done for years and in other industries, and just now, medical education is starting to adopt, you know, some of these approaches or technology. So, I do think that it's going to continue to evolve, I think that what we're doing here is going to continue to trickle down, I think, even looking at the primary and secondary schools, and what are they doing in, especially with virtual learning? How's it working for them? And what can we do for adult learning that is leveraging some of those approaches, but that right now the virtual world and our social distancing has still left a hunger for small groups. It seems like small group learning is going to come back and in different styles, and instead of just doing small group virtual, that concept of pods, you know, it seems like it's more and more tangible. Yeah, where you find a pot of clinicians that you can get together and push out education. in small groups like that. I do think that elements from elementary school, through adult learning in other fields is something that is all connected, and there's a page that we can definitely take from each of them.
Alexandra Howson 26:34
Maybe maybe a good place to kind of wrap up, our conversation is around. I like the way that you kind of envision learning as a continuum. And of course, you know, when you read things around, you can continue medical, medical education. There's reference to that continuum, but I'm not sure if it's something that we can have on a daily basis in the field. But let me ask, what's the best learning experience you've had in recent times?
Oh, goodness, that's it, you're gonna put me on the spot for sure. I have to say, and I don't even want to simplify it as much as it was simplified. But I the best learning experience was a corporate training that we had to do for just sexual harassment training. And it was a course that wasn't ours. It was developed by corporate and their whole approach, I was so annoyed--I was I just wanted to skip sexual harassment. I know, I know, I just wanted to skip, skip, skip and go fast. And I couldn't, I had to sit through and go through it all. But they said they created the program exactly like it should have been, there was a little bit of lecture, there was a little bit of audio. And they stopped, they asked a couple of questions. They did some more education, they created questions in different formats, they created little gaming pieces to it. Like it was just everything that we've talked about that I always, you know, tried to say, this is what we need to do. And it was done.
And I was so frustrated, because I just wanted to be able to skip through and say, Yes, I did my training and move on. And I couldn't just skip ahead and go through it. And it really, you know, did a great job of getting the message across and doing the various testing places for polling and when to learn and when to do an assessment. It was, well, very well done. And to me, I think this was just a really straightforward type of activity. But the methodology and the instructional design that they applied, was there. And that was, you know, just within the past six weeks.
Alexandra Howson 28:56
There was resistance, but they eased you into it. And it's just a really great reminder that often what's in the way is the way?
Yes. Yep, completely.
Alexandra Howson 29:07
Amanda, thank you so much for taking time to talk with me today. And share some of your perspective and your experience in instructional design and, and what learning means to you and your professional life.
Thank you. Thanks for including me, I feel like I, you know, could talk about this for hours because I do--I love what we do and I appreciate the opportunity. Okay.
Alexandra Howson 29:37
Great. So it was, I guess what I love about these conversations is there's so much to potentially dig into. So maybe it will stick around at some point, you know, next year and part two.
The whole time I'm thinking “oh, but I could talk more about this or there. That's not a direction that I want to go but the words just started coming out” but like, okay, we'll go with it.
Alexandra Howson 30:03
If there's anything you want to add, and you have time, we can certainly do that. And if not, we can, we can. We can do a part two.
Okay. Yeah, I like the idea of a continuation.
Alexandra Howson 30:15
That's great. And so I'm hoping to launch in October. I haven't I've, I've done four or five interviews. Now I've got another four to do. I'm going to do it in seasons. And so I'll let you know, when we're launching and what order we're sort of launching and once I have all the interviews, I'm just going to see what the best kind of flow is.
Yeah. And is it just going to be on your website or actually pushing it out on on--
Alexandra Howson 30:49
Well, I'm not sure what platform yet. I'm working with a sound engineer who's going to help me kind of figure out what the best pop up you know? Yeah, iTunes, Spotify, all the platforms. So yeah, that's there's a cross. Okay. Well, you take care.
Thank you. Thanks for including me. Yeah.
Alexandra Howson 31:08
It was really good to talk to you. You too. Bye. Bye. See you soon. Bye.