“There’s an assumption that continuing medical education providers tend to make—we have all made it—that learners know what to do with the information they gather during continuing medical education activities, that learners know how to learn efficiently,” says Medical Meetings columnist, research scientist, and educational technologist Brian S. McGowan, PhD. “While medical education providers offer increasingly well-designed content, and we are becoming increasingly adept at using adult-learning theory, the classic CME model depends on the idea that, when you hand ideas over to a learner whether through a lecture, or a webinar, or a journal—the learner knows what to do with that material. We started to challenge that premise last year, and what we found through extensive research is a need to structure the learning experience to make it simpler, more effective, and easier to retain knowledge that’s been transmitted during education.”

Enter ArcheMedX, a learning architecture McGowan and co-founder Joel Selzer created to both strengthen and simplify the learning process by helping learners take better notes, build in reminders so they can reflect on what they learn over time, search for further information to help them integrate learning into practice, and collaborate with faculty and other learners to validate their perspectives on the information.

“If learners do not effectively leverage these four learning actions, learning is hit or miss at best,” McGowan believes. “We are proposing that education needs to be delivered within a learning architecture that’s not only designed to support note-taking, reminders, searches, and social learning endeavors, but should also help the learner leverage these learning actions more efficiently.”

Evolving a New Learning Structure

McGowan first contacted Selzer as he was gathering examples of collaborative communication models for his book, #SocialQI: Simple Solutions for Improving Your Healthcare. Selzer, with Jason Bhan, MD, had launched an online learning community for U.S. physicians in 2008. Called Ozmosis, the community enabled thousands of licensed and verified physicians to tap into the collective knowledge of their peers. Over time, the software platform behind the Ozmosis.org community evolved into OzmosisESP, an informatics-powered collaboration solution that hospital systems and healthcare organizations such as DaVita use today to improve the flow of information around clinical content and workflows.

“By using OzmosisESP, if someone on the morning shift on 9 West started a new workflow process (such as updating a care plan), evening-shift nurses on 4 East would be able to track it as it evolved,” says McGowan. “The more Joel explained what the software could do, the more ideas I had about how we could transform medical education.” Early last fall, the two decided to spin out ArcheMedX as an entirely new venture. The Ozmosis enterprise software platform, which has been used by tens of thousands of clinicians over the past several years, provided the initial informatics engine and collaborative tools used within the ArcheMedX software. Selzer is now ArcheMedX’s CEO and McGowan is the chief learning officer of the company they co-founded.

To date, McGowan and Selzer have interviewed more than 150 clinicians, educators, residents, and residency directors to explore what can be done to improve a clinician’s lifelong learning experience. What they found is that learners don’t typically have training in note-taking, or setting reminders, or effective searching, much less social validation. “If we asked clinicians if they had ever taken a note-taking class or thought about how to improve their note-taking, 99 percent said no,” says McGowan.

And while most have some way to remind themselves of information they want to retain—by dog-earing a page, highlighting a piece of text, or sending themselves an e-mail—the reminders either take the learner away from what they’re learning, or end up being ignored when, despite good intentions, learners don’t revisit their notes. A few more clinicians copped to trying to learn how to search more effectively, but even those who are more comfortable at searching aren’t always great at finding what they need. “Their ability to find the right answer and use it effectively is numbingly bad,” says McGowan.

And yet these four “natural” learning actions—note-taking, reminders, search, and collaboration—have to take place before learning can happen. “Time after time the clinicians we interviewed told us that their learning begins with note-taking, but they need to take more effective notes,” says McGowan. “Then learners need to build a set of reminders around those notes that enable them to reflect efficiently over time and apply their learning insights to practice. They also need to have access to and be able to efficiently search related pieces of information so they can understand how what they learn relates to the context of their practice or prior body of knowledge. And they need to be able to compare perspectives on the learning with others, which helps to reaffirm and cement the learning into place.”

Built-in Cues

Because the entirety of this CME model is based on what learners have to do before they can actually learn, the system provides gentle nudges at points where the instructor thinks a note would be a good idea, McGowan says. “We’re not being invasive or obtrusive with it, but we integrate note-taking into the planned activity, and provide visual cues—‘Here are three important things that you ought to remember.’ The more that we nudge the learners to use the architecture, and the more the content that our partners are creating is married to the architecture, the more effectively those four actions are being taken.” The architecture also enables educators to introduce new content once the program is live (think of a clinical study that is released three months later) and then nudge the learners to interact with the new content. 

Following a commitment-to-change model, users set the reminders, which are e-mailed to them based on a pre-set delivery schedule. “It automatically archives the notes that you thought were important, and sends them out to you at set intervals,” says McGowan. Learners don’t necessarily even have to open the e-mail—the subject line alone will serve as a reminder about the note they took, though they can link back to the referenced part of the presentation if they want to. “That reminder of just looking at the subject line, just awareness about the note, will begin the retrieval process we know drives long-term learning,” says McGowan.

Educational planners also can overlay the content with a message, perhaps pointing out the three most important things to remember, or offering related content and programs on the topic, or launching a quiz. “Using the informatics’ engine within the learning architecture, we can connect disparate pieces of content so learners don’t have to struggle to make those connections themselves,” says McGowan.

Three Building Blocks

ArcheMedX actually offers three separate learning architectures: one for self-directed learning, one for learning in groups, and a massive online learning model. The self-directed learning architecture connects the first three learning actions to the content so clinicians can create their own “learning stream” by taking, synching, and archiving notes alongside the lesson; searching resources provided by the educational planner (such as journal articles, clinical studies, etc.); and creating e-mail and text message-based reminders in their own words.

The cohort-based model also brings in the fourth learning action (social), so learners can engage in activities with small, trusted groups of clinicians. Using this model, ArcheMedX has begun to flip the traditional learning experience at conferences and live meetings by engaging cohorts of learners online in pre-conference learning activities, and then re-engaging them after the conference has ended.

Key to the cohort-based or virtual classroom model is that learners are participating (and collaborating) in a structured curriculum. As McGowan explains, “This approach empowers clinicians to absorb new information over a series of collaborative exercises, building a virtual community of practice that extends well beyond the walls of a small medical meeting, a regional conference, or a residency program. And, for the educator, it provides flexibility to create broad lesson plans and communicate with and engage learners in collaborative and self-directed learning exercises.

The massive online learning architecture is similar to the cohort-based model, except that it doesn’t wall off individual activities or classrooms of learners within an activity, but instead allows hundreds or thousands of learners to interact with the content and share the reactions and responses to build a collective knowledge base.

Using Learning Action Data to Build Better Education

Educational planners and faculty also can use the unstructured data to enhance what they’re offering. One user might set a reminder at seven minutes into an activity, while another might take a note at four minutes in. These data enable providers to see exactly what learners are engaging with, and how. This “fundamentally changes how we assess learning,” McGowan says. “At the individual activity level we’re using qualitative analyses to assess learning based on the natural language processes. Once we’ve done this across dozens of activities, we’ve just created the world’s largest learning registry of tens of thousands of notes and reminders and searches, all archived and connected back to the pieces of content that were driving those actions in the first place,” says McGowan. “We’ll be able to answer hundreds of correlative or associative research questions, which is where the field needs to go. Instead of asking ‘Does CME work?’ we can ask ‘Why does medical education work?’”

Adds Selzer, “Since the architecture provides a way for educators to assess the learning that’s taking place and update content dynamically based on real-time analysis, our educational partners can now create a continual state of improvement in programs powered by ArcheMedX. Together, we can ensure it doesn’t take 17 years for the next great advancement to become standard practice. “

There are currently more than two-dozen partners (including national medical societies, leading content providers, and academic medical centers) who are beginning to leverage the ArcheMedX learning architecture. To learn more about the system, visit archemedx.com.