To address this problem, we turn to learning science —the marriage of psychology and neuroscience of learning. Learning science makes clear that there are two components to effective education. The first component is the educational content. Educational content represents the critical pieces of information that must be conveyed to patients and providers, from basic kidney functions to understanding lab values. The second component involves the delivery of that content. This addresses the medium through which the content is presented to the patient (e.g., text or video), as well as the nature and timing of the delivery.
In the CKD arena, as in any area of health care, educational content is developed by subject matter experts (SMEs). Even a cursory review of available CKD educational content makes clear that extensive, high-quality content already exists today.
That is, even when a patient is able to access this content, other barriers often remain in their way. Optimizing content delivery is an approach that transcends an educational topic itself, and, in fact, is the purview of learning science. Learning scientists are not clinical subject matter experts, but instead focus on the psychological processes inherent in the learner and the neurobiological basis of learning. They use this knowledge to determine how best to organize and deliver the topic-specific content in a way that optimizes learning and long-term retention.
In an ideal world, you want learners to understand everything they are being taught, and to remember as much of those lessons as possible, for as long as possible. Although initial learning and long-term retention are related, strong initial learning does not guarantee long-term retention and mastery. Let’s take these two goals with us as we assess the status quo in health education.
Think about how patients typically learn new concepts, facts, and figures. An individual is presented with information, usually in the form of printed handouts, classes or videos. The first questions a learning scientist will ask are:
The part of the brain used for information processing is called the prefrontal cortex. The goal of the prefrontal cortex is to use short-term (working) memory and attention to process the information. So, given that working memory and attention spans are quite limited, it becomes absolutely vital that we do not exceed these two attributes during the learning process. If either (or both) are exceeded, learning will be adversely affected, and critical pieces of information will not be learned. We’ve all been there, trying to remember details from a study session, lecture, or even this article! But recall our two learning goals: in order to move from our first goal of speeding initial learning to our second goal of enhancing long term retention, we need to find a way to transfer that newfound knowledge in the prefrontal cortex back to the memory stores in a part of the brain called the hippocampus.
People with stage four kidney disease, the stage prior to kidney failure, often go through a series of classes to help familiarize and prepare them for their available treatment options as they near End Stage Kidney Disease (ESKD). These classes cover dozens of topics, from treatment goals and medications to lab values and nutrition. Like many health education programs, these are often done in person through a series of hour long instructional sessions with a nephrology-trained provider.
This method continues on for the duration of the session, however long and however many sessions are required for a learner to fully grasp the subject matter in a way they can use to manage their own health.
Even if a program takes several days, weeks, or months to reach completion, the educational outcomes realized in the learning science-based approach far exceed those you can expect from the status quo. Additionally, though this example is for an in-person educational program, the same methods apply virtually as well. Given that many visits these days are done virtually in an effort to keep people safe and healthy, and like many we expect this trend to expand in the years ahead, we need to have better tools for educators who will spend their time educating remotely and remain reliant upon traditional methods of instruction without the benefits of face to face interactions.
Oftentimes, in health care settings especially, the realization of these goals is inhibited by barriers including low health literacy, low baseline awareness, and the complex nature of health information being presented. Fortunately, given that these are learning challenges, we can turn to decades of research in learning science for answers.
We have shown that applying these strategies to existing kidney education efforts is not only possible, but that doing so will drastically improve the outcomes we are hoping to achieve. Future articles will discuss how these same concepts have been woven into the fabric of our learning platform at IKONA, with the addition of time-, literacy- and preference-based parameters that lead to truly personalized learning for every patient, everywhere, on-demand.
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