This week in Patient Engagement Design, we saw an engaged patient Britt Johnson (@hurtblogger – great job!) talk about the importance of doctors working with patients rather than talking to or about them … then we saw a video that was all about doctors ‘prescribing’ an eLearning module to patients, with the goal of patient compliance. Is it just me or does this not seem completely condescending?
I should begin by providing some context. First, I’m an experienced instructional designer who has been studying eLearning for many years. I’m aware of the best practices for creating good eLearning, and what makes eLearning engaging. Second, I have been prescribed one of the Emmi modules, so I have experienced the eLearning in question from a patient perspective.
My first sign that this wasn’t going well was when Devin Gross of Emmi Solutions says that doctors ‘prescribed’ the eLearning modules. Immediately, I found myself wondering about the patient’s role in this. Yes, patients are involved in the creation of the content. Yes, Emmi is doing good work making sure the message of the modules uses accessible language for learners (although I find the girlfriend-to-girlfriend reference in the talk is condescending). The issue I have is that this module treats patients as if we inherently inferior. We are “empty vessels” in which knowledge needs to be poured. The message is that if the doctors ‘educate’ patients, then patients will comply. The message re-enforces a patriarchal model, rather than one of collaboration. Patient engagement is about so much more than compliance.
As someone who as been prescribe one of these modules, I found it frustrating. The designers of the modules should please, please, pretty please, read “eLearning and the Science of Instruction“, and when done, take a look at Cathy Moore’s website on action mapping. I was frustrated by the module I was prescribed, because it was simply a page-flipper with voice over. It assumed that I knew nothing and needed to be educated starting from the beginning. It did nothing to try to determine my currently level of knowledge on the subject. If you really want to create eLearning that helps people change behaviour, you need to create engaging eLearning that doesn’t insult your audience. The Emmi modules do look like professionally developed eLearning – but they could be so much better if they actually used some of the things that the last 30 years of research in computer-based-training have taught us. There is an opportunity here to design something that is so much more useful. I see that patient education is an important component of patient engagement; however, it needs to be engaging and respect where the patient is currently at – rather than simply assuming that the patient has no prior knowledge of the subject.
<begin rant> The next bit that made my blood boil was the reference to a ‘random control trial’ that compared the Emmi eLearning module to a paper handout. First off, there have been thousands of studies comparing eLearning to other modes of delivery. The result of 30 or so years of educational research in the field can be summarized as NSD – No Significant Difference. Yes, that’s right. Delivery medium makes NO SIGNIFICANT DIFFERENCE on learning! What matters? Design. Yup, a well designed eLearning module will perform AS WELL AS a well designed paper pamphlet. A poorly designed eLearning module will result in poor learning outcomes. It isn’t about the medium, it is about how effectively the designers use the medium in order to deliver the message. </ end rant>
There was one important take-home message from the video, and that is the importance of explaining to patients why they are being given specific directions. If you tell a patient why you are asking them to do something, they are more likely to comply.
It feels like the course is trying to give voice to patients by including the patient ignite talks, but then the course content goes on to completely ignore what the patient had to say. This feels like a page right out of anti-oppression training – when you give space for the oppressed to speak, but then proceed to ignore what they say, it is still oppression. Patient engagement requires more than compliance – it requires a complete shift in how we think about the relationship between physicians and patients. There could not have been a worse pairing of patient ignite talk to content presentation (sorry medx folks).