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Nursing Informatics & Technology: A Blog for All Levels of Users

The ‘Blended’ Way of Learning: Not Your Mother’s Clinical Information Systems Training

Published November 25, 2013 8:58 AM by Angela Lewis
Blended learning is now used within the training plans of clinical information systems (CIS) implementations at countless healthcare organizations, from 700+ bed medical centers, to critical access hospitals, to outpatient surgical centers, to physician offices and home health agencies across the United States. The blended way of learning has to be a collaborative effort with clinical interdisciplinary leadership, education and clinical informatics staff to develop, deliver and achieve your organization's learning plan goals and measureable targets.

Blended learning has also proven to be among the most popular choice for learners at institutions of higher education. The majority of colleges and universities have at least one, if not more, well-established online degree programs composed of blended learning curriculum.

Research has proven that online learning alone is not enough. The evidence shows that blended learning - combining in-class, facilitated training with e-learning - is much more effective than either alone. As cited in the U.S. Department of Education's "Evaluation of Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies" (Revised September 2010), "Students in online conditions performed modestly better, on average, than those learning the same material through traditional face-to-face instruction" (p. xiv) and, notably, "Instruction combining online and face-to-face elements had a larger advantage relative to purely face-to-face instruction than did purely online instruction" (p. xv). Learners perform better in blended courses.

In healthcare information systems implementations the use of the blended learning approach combines a variety of learning delivery methodologies. Additional benefits to be attained using blended learning include: allows organizations to compensate for limited classroom space; provides a transitional opportunity between online instruction and face-to-face classes and minimizes the time required for end users to train. End users report blended learning provides the convenience of online learning along with the social instructional interactions of facilitated in-person classroom courses. Later, more about facilitated courses.

A blended learning approach typically includes some (if not all) of the following components:

  • 1) In-person, facilitated, just-in-time classroom training
  • 2) E-learning (computer based training (CBT)
  • 3) Educational materials/media
  • 4) The train the trainer (TTT) model
  • 5) Open labs


Facilitated Training

Facilitated classroom training is not the same as traditional instructor-led training, which puts the onus of knowledge "transfer" primary on the instructor. In order for clinical end users to become optimal users of the new information system they must be held accountable for learning, be engaged and take a proactive role in their knowledge acquisition. Learning is the responsibility of the adult student/clinical end user. During clinical information systems implementations it is imperative for clinical end users to take the initiative to perform hands on practice, practice, and practice some more in the Test system prior to go-live.

Additionally the staff development/education and clinical informatics/IT departments, in collaboration with system subject matter experts and champions are responsible for organizing and providing clinical end users with in-person, instructor facilitated classes.

In-person facilitated classes should be a combination of: 1) basic course content delivered classes; and 2) hands-on, self-paced, role-based scenario guided sessions. The role based scenarios should simulate future state workflows and performance of system tasks such as: accessing a patient census; associating yourself to a patient per your clinical role; using MAR; creating hand-off documentation; how to change a specimen collection order from lab to collect- to nurse to collect; viewing department tracking boards; trending vitals and I&O, etc. Both types of in-person training sessions should be guided by your organization's policies and procedures and focused on patient care delivery activities that support learning being implemented into practice.

Just- In - Time Training

Adult learners are particularly receptive to learning new information when it is delivered to them right when they need it. "Just-in-time" training refers to a method of providing training right when it is needed, not weeks or months too earlier or too late. Just-in-time training eliminates the need for refresher training due to knowledge loss experienced if training proceeds, over an extended period of time. Just-in-time training prevents knowledge loss because staff are soon able to put the material learned into actual use upon returning to the clinical setting.

E-Learning and Other Educational Media

In addition to in-person, facilitated classroom training, the project's education developers should not overlook creating learning materials especially for e-learning/online use. The e-learning modules should ideally be packaged into bite-sized chunks of no less than 15 minutes and no more than 40 minutes in length. E-learnings such as those developed in Captivate allow clinical end users to take full advantage of interactive features such as video, audio, animation and illustrations. Utilizing e-learning allows your clinicians the convenience of choosing where and when to undertake their learning and provides end user staff with more scheduling flexibility. Incorporating e-learning into the training plan also means clinical informatics and education staff can update online materials rapidly so clinical end users can access the most up to date course content. Unlike traditional paper based courses which become outdated quickly as system upgrades are rolled out and new clinical practice evidence emerges.

Educational materials/media should not be limited to online media or e-learnings. The original system manuals provided by the vendor are often dry, voluminous and written in non-clinical speak. The original vendor's manual(s) should be edit and revises thus customizing them into smaller versions that correlate system functionality with future state work flows, and unique organization policy and procedure. Customized your end user manuals in such a way will definitely improve their usability and value for your clinical staff.

Additionally, ensure hard copy, laminated and pocket size job aides, quick tips and cheat sheets are created and provided to staff end users prior to go-live. These types of hand outs will help to further reinforce information provide from both the e-learnings and the in-person facilitated training classes.

Train the Trainer (TTT) Model

The TTT model reflects proven research that people who train others recall 90% of what they teach and that people learn new information through trusted social networks. The train the trainer model is the standard in clinical information systems implementation and is also recommended as such by many vendors. The TTT model will also help create a team of your organization's system subject matter experts and champions who are capable of transferring solution knowledge to their peers.

Open Lab

Lastly if your organization has the space and equipment budget, plan for having an open lab - a space with desktops or laptops (and earphones) located away from the clinical units and departments that staff can come to for additional practice time. Remembering that some units/high volume areas in your healthcare organizations are less conducive to staff learning than are others. Think about staffing your open lab with subject matter experts and champions to give support to end users who show up to practice in the test system.


posted by Angela Lewis


Totally agree with the blended approach for clinical systems training. Just in time learning is very important post training, along with review sessions to go deeper into specific workflows, e.g. hanging and documenting blood, Individualizing  the electronic care plan.

Joan Lundgreen, Clinical Informatics - 503-557-2192, Providence Willamette Falls Medical Center December 31, 2013 11:59 AM
Oregon City OR

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    Occupation: Nursing informatics experts and enthusiasts
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