For a recent edition of HTN Now, we were joined by Henrietta Mbeah-Bankas, Head of Blended Learning and Digital Learning and Development Lead at Health Education England (HEE), for a presentation on innovation in education and training of the health workforce.
Henrietta began by outlining the objectives for her session: to look at how technology can be harnessed effectively in the development and delivery of education and training; the conditions needed to facilitate evidence-based education approaches; and how we can ensure that education and training are responsive to a changing landscape.
Online learning technologies
Henrietta shared some examples of online learning technologies, such as e-learning, virtual learning environments (VLEs) and learning management systems (LMS). These technologies are used to help HEE, Universities and practice partners manage content and ensure that it has been quality assured and curated to meet learners’ needs. Henrietta noted that they also help with curriculum mapping and planning, learner engagement, administration, communication and collaboration.
She highlight many examples of resources to support online learning, such as Google Classroom, Canvas, Moodle, Blackboard and Panopto. Henrietta noted that the pandemic has enhanced the use of these tools in educational settings from universities to primary schools.
Simulation and immersive technology
This part of the session explored simulation and immersive technology, to replace or amplify real experience with guided experience. This could span technical and functional expertise training, support development of problem-solving and decision-making skills, and build interpersonal and communication skills, along with team-based competencies.
Henrietta explained how simulation and immersive technology can “range from physical reality right up to virtual reality, and everything in between”. The spectrum between physical reality and virtual reality includes augmented reality (which adds to the physical world); mixed reality (adding and reacting to the physical world) and augmented virtuality (adding to the virtual world).
“Examples of these types of simulation and immersive technologies include human simulators and simulated clinical environments, which is critical to delivering healthcare education in the 21st century,” Henrietta continued.
“It became even more important during COVID, when sometimes people were not able to actually go to a healthcare environment. Having that simulated clinical environment away from the units was really important.”
Procedural or task trainers are another example, along with electronic medical records. “Before somebody actually completes their training, they have insight into what a medical record looks like, utilised it, they have gained skills around accessing and managing medical records.”
The last example is patients as educators. “I particularly like this one,” Henrietta noted. “When we talk about simulation and immersive technology, we always think about the higher end of it. Sometimes we can forget that role-play is actually simulation too, and patients as educators sits in that category.”
Moving on, Henrietta posted a question: “How can we practically apply these technologies in your education and training of the workforce?”
She supplied some answers:
- Virtual ward rounds using smart glasses and HoloLens. “HEE is very invested in this area,” Henrietta shared. “We have some smart glasses and HoloLens which we loan out to various areas that want to test this technology.”
- Smart ward rounds with telepresence robots. “I was part of the Topol review where some colleagues were expressing anxiety about being replaced by robots. I’ve always said that it’s not about replacing, it’s about enhancing what we do as professionals and offering different opportunities. In education, it’s really important that we are starting to use these technologies.”
- Primary care consultations. “Many of us experiencing primary care as users know that you now have to fill out an online form and use various technologies. It depends on your practice and some are more advanced than others, but there is a whole raft of technologies now being utilised in primary care consultations.” As an example, Henrietta highlighted how Leeds Medical School is embracing the potential of technology to train the future medical workforce through use of virtual learning portals, ebooks, apps and more.
- Immersive 360 video. “This provides us with opportunities to learn from areas that are quite unique or niche,” Henrietta said. She pointed out that this technology is also useful when looking to the future. “In order to enthuse people about going into these roles, they need some insight into those niche areas and sometimes immersive 360 videos provide the opportunity for that.”
- Remote assistance/proctoring, wherein examinees can take practical exams whilst an examiner continuously monitors their work. On this, Henrietta commented: “I think there are so many opportunities that technology offers us that sometimes we don’t utilise. With the century that we are in, there are opportunities to maximise the use of tech in ways like this.”
Benefits of technology in education and training
Henrietta expanded on some of the benefits of using technologies in education and training, firstly focusing upon online learning.
Benefits here include flexibility, with users able to choose the location, time and method of their training; the ability to facilitate networking opportunities between educators and learners; and opportunities to reuse and share content between courses and professions. Another benefit is the ability to provide wider access that takes into account people’s personal commitments and barriers to in-person learning, ultimately enabling them to access education in a way which supports their own circumstances. Alongside this, Henrietta highlighted how technology can enable global education and training; the development of self-directed learning; digital literacy skills development; and improve problem solving and time management skills.
With regards to simulation and immersive technology, benefits include absence of harm to patients through extended reality; the ability to undertake deliberate and repeated practice with feedback; opportunities for curriculum integration and a range assessment; exposure to uncommon events and a range of difficulties; and the ability to deliver multi-professional training at scale.
“Fundamentally we need to appreciate that all of these technologies are not here to replace our face-to-face, hands-on, in-person clinical learning,” Henrietta emphasised. “They are there to enhance, to complement and to provide opportunities where hands-on opportunities don’t exist. Think about the aviation industry – if you have not gone through a simulation for flying a plane, there is no way anybody would put you in the pilot seat. It’s similar within healthcare – it is so important for healthcare to embrace simulation and immersive technology to prepare our workforce and develop their confidence before they actually arrive in clinical areas for hands-on experiences” and throughout their training.
“It doesn’t come without challenges, of course,” Henrietta noted. “Access to the right technology can be a challenge, for example, and then you can have further complications such as poor connectivity.”
Another challenge is over-reliance on technology leading to an absence of in-person contact. “People can get too used to digital means, which means they don’t want to come in and see you in person,” she said. “We know that if you are to provide the full benefits to healthcare workforce education, there is a real need for that in-person contact alongside technology use.”
Faculty development from both a clinical and academic perspective is another area of concern; it is one thing for academics to be able to deliver engaging lectures and demonstrations in person, Henrietta pointed out, and another thing entirely to be able to engage students in an online or simulated environment. Going forward, HEE will be ensuring that training programmes are in place to support faculty in delivering the best level of education both clinically, in-person and virtually.
Evidence around outcomes can be “patchy”, Henrietta acknowledged. “There is evidence in various places, but it is patchy in terms of knowing for sure whether technology use actually results in a different patient outcome. The evidence in existence tends to focus on user experience.” Going forward, she says, this area of evidence needs to be developed as the technologies continue to be used.
On digital literacy, Henrietta said: “Are students prepared? Do they have the digital literacy skills to utilise the tools that are available to them? Do members of the faculty have the required levels of digital literacy?”
Looking next at culture change, Henrietta commented, “Fundamentally, all of this is about change. It’s about doing things and looking at things differently. So how do we ensure that our systems are ready for that change? Doing things differently has implications for preparedness, for time, for investment. It’s so important that we think about how we can support that change.”
Finally, Henrietta highlighted the role of regulatory and professional body restrictions around the use of technology in some areas, particularly in clinical practice.
“I am very pleased to say that HEE has been working very closely with our regulatory and professional bodies who are really investing in gathering the evidence and supporting flexibility for the use of technology in education delivery,” she said.
Health Education England’s long-term plan
Finally, Henrietta laid out HEE’s strategy for embracing online learning and immersive technology in the future.
Henrietta emphasised the importance of investment – in people, technologies, and processes. Areas promoting these currently include blended learning, technology enhanced learning, HEE’s digital academy, and the library and knowledge services. “These areas, which sit under the Digital Innovation and Transformation Directorate, are really key in shaping this agenda.”
On supporting digital literacy development, Henrietta said: “We have develop an interactive digital skills assessment tool.” This is set to support digital literacy for the “current workforce, future workforce and right up to our senior leadership”.
Other areas of focus include faculty development through the Virtual Hybrid Learning Faculty, establishing a solid foundation of information and expertise for the workforce to draw from. They will use guidance from a variety of sources, feedback and evidence to inform their future strategies where technology is concerned.
Partnerships are also being put in place with advisory groups via international webinars to broaden the scope of digital technology and its uses within the education healthcare at large.
These workstreams centre around HEE’s ‘quadruple aims’: improving the health of the population, enhancing the patient experience of care, reducing the overall cost of healthcare and providing joy at work.
“We know that if a person is happy, this leads to better patient outcomes,” Henrietta said. “For me that is a key aim.”
In order to improve digitally enabled education within health and care across England, HEE recognises that they must understand the current landscape.
Concluding her session, Henrietta said: “We have technologies, yes, but let’s not use technologies for the sake of it. We need to think about new learning pedagogies that we can take advantage of to utilise the technologies that we’ve got, that can provide us with a sound outcome… it’s about recognising the outcomes you need to achieve and identifying which technology or educational approach can get you there.”