This is a process blog of my learnings from Stacie Rohrbach’s Learner Experience Design course taught in the School of Design at Carnegie Mellon University, Spring 2019.

January 15 — Class 1

Hi there! My name is Amrita and I’m a Master’s student in the School of Design (MA). Before Carnegie Mellon, I was working in customer support and project management at Fitbit. I’m very grateful for my work experience because it led me to Design and to CMU.

Sadly, I missed the first class, but was able to catch up with a few of my fellow classmates. All in all, I’m really excited to take this class.

From our class website:

Designing experiences that engage people in educational activities that enhance their learning through meaningful, memorable, and enjoyable interactions with information is vital to the well-being and advancement of our society.

This quote could not resonate with me more. As a lifelong learner, I’m a full believer in the power of education. Education has the ability to nurture, encourage, open, and transform. One day, I hope to work in the field in one way or another as a designer. I can’t wait to start investigating the many disciplines that contribute to designing experiences for learners.

UPMC Readings — Main Takeaways

Background: Our class will be working on a project sponsored by UPMC. This project will focus on educating patients, physicians, and caregivers to reduce readmission rates at local medical facilities. At this stage, we’re currently researching the problem space.

Patient discharge care is a highly complex process that involves multiple levels within and outside the hospital organization. Levels of care include primary care providers, nurse practitioners, case managers, patients, pharmacists, health care providers, and a patient’s support system. Currently, patient discharge is highly susceptible to poorly standardized processes, lack of timely follow-up arrangements, and poor communication between hospitals and PCPs. These pain points result in higher readmission rates, often within a patient’s first weeks post-discharge.

There is no single intervention or set of interventions that can prevent avoidable readmissions. One best practice that can aid reduction efforts is providing comprehensive, structured, flexible discharge plans supported by clinical case managers (nurse practitioners). These case managers can provide care using their medical knowledge and training to address patient-specific needs, provide education, and advocate on behalf of the patient. They ensure care is communicated and coordinated across all touchpoints.

Federal government intervention with the Affordable Care Act prompted hospitals to start focusing on reducing readmission rates. Beginning October 2012, section 3025 of the ACA required the reduction of payments to hospitals with excess readmissions.

January 17 — Class 2

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Ellen Beckjord came in to talk to us about readmission rates at UPMC. She shared loads of great information which I’m still in the process of digesting.

A few insights that stuck with me:

  • Readmission is a multidimensional problem that requires multidimensional solutions. There is no silver bullet solution. Reducing rates will require an integrated approach across various levels of healthcare organizations.
  • A significant contributing factor is the misalignment of healthcare plans and healthcare systems.
  • Patients discharged to skilled nursing facilities (SNFs) represent a large part of those readmitted. There is an opportunity here to reduce both readmission rates and costs.
  • Currently, the patient discharge process is a chain that is susceptible to fragmentation, lack of coordination, and poor communication.

Ellen’s talk made me think about the concept of a wicked problem.

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Source: CMU Transition Design

The issue with readmission rates is very much a wicked problem. As Ellen mentioned, there isn’t a one-stop solution. Reducing rates will require collective, integrated efforts across multiple spheres of influence.

In terms of next steps, I need to get a better grasp of this multidimensional, complex issue through continued background research. There’s a whole new set of terms, abbreviations, processes, and pain points specific to the healthcare world that I’d like to familiarize myself with.

Looking forward, I plan to:

  • Continue reading materials provided by UPMC.
  • Reach out to a few friends working in healthcare for more insight (doctors, nurse practitioners, pharmacists, and community outreach coordinators).

Andrew Reading

I enjoyed diving into the mind in this chapter about Perceptual Blocks. Andrew’s relatable and humorous tone made this a fun read.

Perceptual blocks are obstacles within our minds that hinder us from perceiving problems clearly or in new ways. Although natural parts of the cognitive process, these blocks are important to understand, recognize, and overcome. By doing so, people can better solve problems.

It’s important to understand how the mind works in order to avoid its problem-solving pitfalls, appropriately frame issues, and allow for more creative thought.

For future reference, I’ll briefly summarize and include my notes about each block.

Stereotyping

“You cannot see clearly if you are controlled by preconceptions.”

  • Hinders our ability to see from new perspectives and combine information in new ways, the crux of creative thinking
  • It’s inherent within the mind as it decreases the huge task of information processing.
  • Context is very important when it comes to memory.

Difficulty Isolating the Problem

“Problems we face may be…obscured by either inadequate clues or misleading information.”

  • Problem-solvers must be continually alert in order to properly perceive a problem.
  • This block leads us to solve for symptoms, rather than core issues.
  • Appropriate problem isolation is largely due to the “tendency to spend a minimum of effort on problem-definition in order to get to the important matter of solving it.”
  • How do problem-solvers then isolate problems appropriately? Problem definition seems to be a very important step.

Tendency to Delimit the Problem Area Poorly

“It is also difficult to avoid delimiting the problem too closely.”

  • Overly strict limits are constraints of the mind.
  • This block and the previous block made me think about how important it is to frame and reframe problems with due diligence. How problem-solvers approach a problem guides what solution ends up coming out of it.
  • The broader a problem can be thought about (within reason), the more room there is for conceptualization.
  • This discussion also made me think about how complex and integrated our world is. Andrew mentions that as we continue zooming out when defining a problem, we “usually [become] involved in interdisciplinary considerations.” This is a little overwhelming to think about because every problem then becomes a wicked problem.

Inability to See the Problem from Various Viewpoints

“It is often difficult to see a problem from the viewpoint of all the interests or parties involved.”

  • Seeing a problem from all viewpoints leads to better conceptualization.
  • Vertical vs. lateral thinking: breakthroughs usually result from lateral thinking.

Saturation

“You think you have the data, even though you are unable to produce it when needed.”

  • Another block that hinders our ability to see in new ways.
  • Based on Andrew’s description, this block is more than just information overload. It includes the inability to recall information.

Failure to Utilize all Sensory Inputs

“[Problem-solvers] should…be careful not to neglect any sensory inputs.”

  • The interplay between all senses helps solve problems.

Based on the above blocks, my main question is what are the best methods to overcome them? Many methods might be context or problem specific, but I hope to explore ways in which these blocks can be “busted.”

January 22/24 — Classes 3/4

It was great contextualizing Andrew’s Perceptual Blocks reading through in-class “blockbusting” activities. Overall, I like the step by step process we’re taking in this class. We’re building an arsenal of theory, applying it within our own contexts, and then bridging over to the issue of UPMC readmissions. This step-by-step process is helping me expand my thinking and problem-solving abilities and start asking relevant questions.

Blockbusting

We focused on busting our perceptual blocks with 6 activities. I’ll briefly summarize a few takeaways from each one.

Block 1: Stereotyping

We drew various images (tree, television, scallion, refrigerator) and then walked around the room.

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  • Absence of tree roots: We don’t represent the things that are invisible to us. There may be more information that isn’t immediately visible that carries more importance than we realize.
  • Old TVs: Our prior experience influences our current perceptions. We should consider how much information is based on the present or in the past.
  • Closed refrigerators: We are used to seeing things at rest or in their static states.
  • It’s important to understand what useful information might be missing from the initial view of the problem space.

Block 2: Difficulty Isolating the Problem

We thought about redesigning the water bottle by thinking about the ways in which water is carried. This was an exercise in scale.

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  • Once a problem is framed in a certain way, we might eliminate an idea prematurely.
  • Moving among levels of scale, zooming out and back in, can help reframe problems.

Block 3: Tendency to delimit the problem area

We thought about the three essential qualities of sunglasses, then attempted to redesign sunglasses without these qualities.

  • Taking things we think are critical to a concept away can change thinking.

Block 4: Inability to see tasks from various viewpoints

We thought about an event from the perspective of a participant’s boss.

  • When considering all stakeholders, a challenge usually becomes more robust. There are always more people involved in an experience than we might realize.
  • This block will be especially important with the UPMC readmissions issue.

Block 5: Can’t recall essential content due to saturation

We drew our phone’s lock screen.

  • “Expert blindspot” that causes us to gloss over information.
  • It’s important to consider what things we do on autopilot.
  • When thinking about UPMC, are there things that patients, nurses, doctors are doing that make the task difficult because they are glossing over necessary info? Where are UPMC rituals and where are there opportunities in the routine to intervene or tweak?

Block 6: Failure to utilize all sensory inputs

We considered designing a fire alarm campaign leveraging the sense of sound.

  • We live in a world where we’re constantly combating visual fatigue.
  • Sometimes, we can provide a more lasting, richer experience if use more senses.

After blockbusting, we started nesting these blocks within the UPMC space.

At first, it was hard to think about our blocks in relation to UPMC. We started tackling this by first identifying our thinking, and then deconstructing it.

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Through this approach, we were able to think about new areas within the readmissions process that we had not considered previously. We thought out doctors and how they support one another, exchange of information, pharmacists, and patient’s support systems outside of the hospital.

January 28 — Class 5

During this class, we took a deep dive into Dirksen’s chapter about learning styles, discussed Bernice McCarthy’s 4MAT system, and started an activity related to the 4 quadrants.

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Discussion of Dirksen’s chapter on learning styles

I’m really interested to see how learning will manifest in the UPMC space. The medical space is filled with a lot of complex information, and at every turn. Being able to take information and make it both consumable and actionable will be challenging. I also imagine there’s a range of learners within this space — from novice to experienced. Coming up with an intervention that’s flexible enough for this spectrum of learners is another important consideration.

The research phase of this project is going to be fundamental. We’ll need to robustly define our stakeholders and what their specific learning needs are. Although this seems like an overwhelming task, I’m confident that we’ll be able to do this given the awesome step-by-step nature of this class. As novice a learning experience design learner, I love the scaffolded nature of this class.

In terms of the 4MAT system, it was interesting to see where graph I fell. I feel like I may have done the quiz incorrectly, so will try it again at some point. One big takeaway from this discussion/activity is a robust learning experience takes a learner through all four quadrants.

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Source: 4MAT website

Dirksen Chapter 3

It was great to dive deeper into Dirksen’s discussion about learning goals. Defining clear, intentional, and specific learning objectives is the best course of action when designing a learning experience. This not only helps define objectives in the minds of a learner but also helps guide designers as they develop a learning experience.

The latter point will be especially useful to think about as we enter the UPMC project. As newbies to LxD, it’ll be important for us to clearly define our project’s learning objectives. These objectives will give us good, solid guidance as we navigate through the new territories of both learning design and healthcare. This only makes me think that the research phase of the process will be really important. We’ll need to clearly define our focus area within the complex healthcare space, identify our stakeholders and their specific learning needs, and develop clear objectives that fit within that. Our research will require due diligence.

Dirksen’s provides the following breakdown of determining learning goals:

  • Identifying the problem
  • Setting a destination
  • Determining gaps
  • Deciding the pace of learning

As we saw with perceptual blocks, identifying a problem is challenging. Dirksen, however, provides great questions that’ll I’m sure will be very useful to add to our toolkits. Examples:

  • What bad thing will happen if they don’t know this?
  • What are they actually going to do with this information?
  • How will you know if they are doing it right?
  • What does it look like if they get it wrong?

Further, it was interesting to think about whether or not there is actually a problem to be solved. To this effect, it’s important to understand the needs of learners and what they are trying to get out of the experience and frame an intervention appropriately.

It was insightful to read about fast and slow learning. This made me think about managing learner expectations. Learning new knowledge or skills requires a varying degree of time, practice, and patience. We need to be realistic about what we are trying to accomplish and how much time and practice is required from our stakeholders. Depending on what type of learning intervention our team chooses to implement and the knowledge/skills needed, we’ll need to take expectation management into consideration.

Finally, while reading this chapter, I was reminded of my experience at Fitbit. As a Product Specialist in Customer Support, I worked with instructional designers to create learning modules for our global support staff. Our support staff needed to be well-versed in specific product information and processes in order to provide guidance to customers. To help our agents acquire this knowledge, our instructional designers would create specific learning modules. These designers would always drive home the point of defining learning objectives from the get-go. These objectives were important because they would help frame a learning experience that often involved massive amounts of information.

February 4–Class 6

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Stakeholder mapping

This class session was all about understanding stakeholders. It involved breaking into our project groups, brainstorming different areas of interest, and defining high-level learning objectives. Overall, this session gave us a better understanding of our shared group interests and more clarity about potential design opportunities.

The highlight of the class was defining problem areas and mapping stakeholder relations. This activity was initially challenging because defining objectives within the large healthcare problem space felt overwhelming. The overwhelm made me feel mentally blocked. But, we were able to push through this challenge by scaling in/out and connecting dots as a group.

It was also awesome to see areas of interest emerge. Our group’s major themes included:

  • Collaboration between people
  • Personalized care
  • Patient support system (friends, family, case managers)
  • Fragmentation and miscommunication between points of the care process
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At the end of class, Stacie mentioned the importance of paying attention to connections across stakeholders — to points of affinity and points of opposition. The real challenge will be navigating through points of opposition. One way to deal with opposition and get group buy-in is to understand points of affinity. Points of affinity will serve as great entry points into building consensus. This point reminded me of Transition Design. A big theme in this class is the idea that designers can help build more empathy between stakeholders with conflicting viewpoints if they first help these stakeholders understand what they have in common.

As an ending note, this session is helping us discover our own assumptions and questions as we move into our UPMC project.

February 6 — Class 7

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Defining Stakeholder States and Bridging Gaps Activity

In this session, we broke into our project groups and continued defining problems within the healthcare space. To guide our thinking, we considered the following questions:

  • What are the results of the problems you’ve identified?
  • What are the bad or problematic things that can happen if these issues are not addressed?

It was challenging to move from problem mapping to thinking about concrete contributing factors. Many of our possible problematic outcomes might have been a result of a combination of factors — a combination of gaps in knowledge, skill, motivation, environment, and communication. This refers to Dirksen’s five factors that contribute to problems:

  • Knowledge: Learners are not given ample information or are unaware of information.
  • Skills: Learning takes practice. Learners are not given ample time to practice skills or use the information given. They need to move to active learning.
  • Motivation: Learners lack motivation (extrinsic/intrinsic). A good question to ask is how can you get people on board?
  • Environment: The space or context may not be conducive to a learning experience. Even if it’s good, the amount of time spent in the space may not be enough. As an example, it’s common for nurses and doctors to have expert bias with information, running through it quickly during the discharge process. A patient, however, may need more time to process this information.
  • Communication: A central question is how are going to frame information or choreograph the experience in a way that makes sense to a learner? There is a big design component here/form matters.

After thinking about concrete causes, we dove into defining preferred states. It was fun to think of an ideal world where the discharge process is seamless, easy, and personalized.

Next, we moved into a discussion around bridging gaps between current states and preferred states. Dirksen and Bloom provide us with guiding insight:

  • Is this something they would use in the real world? Think about the task you are putting in front of a learner. This connects directly to the 4MAT cycle in that we must consider the last quadrant and how people apply learnings more broadly. How can we provide them with a rich, rewarding learning experience that will carry through to other parts of lives? How do we create enduring knowledge and skill?
  • Is it a fast/slow skill (pace learning)? This refers to the amount of time necessary to acquire skills. Changing a mindset or views, ones that may be ingrained over time is difficult. How do we begin to help people to make this shift? How do we address slow skills? Pace layering is important here. Mental models are helpful for pace layering. If we can help learners see the snowball effect of learning, that’s good. At this stage, we begin to break things into chunks and get a sense of the bigger picture. But, this requires reinforcement.
  • How sophisticated must the learners understanding be (Bloom)? Refers to the action words associated with each type of learning. What do you want people to do? How do you know they are beginning to grasp everything you are trying to teach them? How do you measure?

Finally, we ended class with a discussion about leveraging prior knowledge in learning experiences (Ambrose). Key factors:

  • Activated: How can you activate by calling up past experience and relating these experiences to the present project they are working on? How can this be of use? This involves using the McCarthy wheel and helping with the fourth quadrant.
  • Sufficient: Do people have enough to complete the task. Which prior experiences can you pull?
  • Appropriate: Is it appropriate to the task? Does it call up the right prior experience learners can actually leverage?
  • Accurate: About debunking misconceptions. This is where you get into slow skills. What you can pull from past experience and how can you do it in a way that helps people move past misconceptions (misconception about physicals, communication among doctors)?

February 12 — Class 8

This class session was fun-filled. We played musical chairs and discussed the intersection between game theory and learning.

At the start of class time, Stacie gave us the following objective: play musical chairs as a class. Without no further instruction, we were left to devise a system for the game specifically for our classroom context.

It took about 15 minutes for us to self-organize and come up with the game’s framework. Then, we played.

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Pre-game: coming up with a system // Mid-game: buy-in achieved + End-game: maintaining rules & expanding imagination

Post-game, we debriefed about our experience. A few insights from this discussion:

  • When planning the game, people started to take on different roles. A few people emerged as leaders, while others became observers.
  • Through a process of trial, error, and discussion, we developed a system.
  • Comradery built as we played the game.
  • Buy-in increased when we saw the game successfully unfold within the framework we had created.
  • When it came down to two people, the fairness of the game was called into question. We could have either chosen to maintain our existing rules or modify based on context. Although we choose to maintain our rules, it was interesting to this resistance develop.

Thanks to this discussion, I’m now thinking about ideas around building buy-in, creating appropriate frameworks, and setting the right objectives. A question I have is: in a learning experience, how can we best forecast or create the conditions for a buy-in point?

Building engaging experiences & motivating play

Stacie introduced The Magic Circle (Zimmerman and Salen).

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The Magic Circle is the boundary within which a game takes place.

  • Rules: includes set up and fairness. How malleable are rules? Is there a static structure or can is it flexible?
  • Feedback: What do rules constitute?
  • Immersive: The game takes you to an immersive, encompassing space.
  • Imaginary: builds the imagination. This is where designing the space comes into play.

This circle doesn’t exist on its own. Players bring concrete real-world fears and insecurities into the circle. As players enter the circle, their fears/insecurities start to transform and diminish. If successful, they enter back into the real world, richer as a result of the game (or learning experience).

The boundaries of the circle are also important. They can be permeable/impermeable. If a game system is closed (impermeable), then all actions of a game are governed by the game’s rules. If the boundaries of a circle are open, then players can enter and exit the system.

Finally, how we frame a learning experience is an important component of how it’s received.

Ambrose reading

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Value-Expectancy Model (Ambrose)

Key points:

Value: what kind of benefit do learners get from the learning experience?

  • Attainment: what do learners gain from mastery/knowledge? What will they learn as a part of this experience?
  • Intrinsic: The internal desire to participate.
  • Instrumental: extrinsic motivation.

Expectancy

  • Efficacy: How do you convince someone that they can do it? Efficacy will be an important part of the UPMC project. Should be positive. What are the specific actions that will inspire the right end goal?
  • Expectancy-positive/negative: what are the variables and their range between positive/negative?

It’ll be important to understand value and expectancy. What are different value components our project audiences are going to bring with them and how can we help them bring positive expectancies?

We then worked through the UPMC problem space using Ambrose’s model. We identified the goal of instructing patients on their specific care process + why it’s important. This also connects to the idea of personalized care. At first, it was difficult to think through each of the categories in Ambrose’s model. But, as we discussed as a group, things became a little clearer.

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12/14 — Class 9

We started this class by finishing up the magic circle activity from last class.

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Magic circle exercise

I found this exercise really helpful. We’ve started to find more clarity and focus on a project topic. Our high-level goal (which may change) is to instruct patients on their specific care process and why it’s important. We want a patient to take ownership/care of themselves. We want to promote this ownership by ensuring that hospitals provide a personalized, clear, and manageable care plan. This plan may consist of various components that are scaffolded during a patient’s hospital stay and continue through the discharge process until they are back in the real world.

Dirksen Chapter 5

Key points from Dirksen’s chapter on attention:

  • Tell stories: Make learners feel capable. This is connected to the magic circle. To help learners feel capable, they need to step outside of themselves (can leverage scaffolding and personal experience). One way to enable this is through role-playing. This also connects to the idea of shelves where content lives. When we’re trying to enable a learner to understand something deeply, we need to find ways to marry new knowledge and skills with things learners have already learned in past (their mental models).
  • Add surprise: Give unexpected rewards that learners don’t know are coming. Remember surprise can also be scary. Create a dissonance. This occurs when you have two competing mental models the create disparate ideas. This reconciliation can be turned into a teachable moment in a person’s/learner’s mind.
  • Show shiny things: pique curiosity with the novel, the mysterious, or the visually compelling. This is also connected to the idea of dissonance. Also, connects to rhetorical question in which learners should be shown instead of told. Rhetorical questions that will cause learners to think critically.
  • Peer pressure: not in a negative way, but in a way that leverages collaboration or low stakes competition.
  • Leverage habits: Creating a learning experience that integrates well into habits or previous experiences. Problems occur when people have to adapt to completely new ways of living. How can we help scaffold important changes?

Dirksen’s point about telling stories connects to an idea our group developed during the magic circle activity. We were thinking about ways to engage patients in their discharge process. One way we thought might be good was through role-playing. Role-playing would provide constraints within which a patient could leave some fears behind and allow them to see new perspectives which could be important in helping them develop new mindsets.

As an ending note, these concepts are very important to consider when leveraging attention and thinking about how people can build habits or carry a learning experience with them.

12/19 — Class 10

During this class, we first debriefed about our Ambrose chapter 2 and Dirksen chapter 4.

On a high-level, Ambrose discusses memory and how learners retain information. One salient point that stuck with me was the idea of providing an explicit mental structure for learners. How can we tap into common ways learners organize information and make a structure obvious/easily adaptable? This question is important to consider because of the diversity of learning styles. It’s important to provide a flexible enough structure to allow learners with different learning styles to easily engage. Different learners may want information framed differently, therefore the integration of multiple structures is encouraged.

A few more salient points and insights:

  • Make connections in a learning experience explicit and use reinforcement techniques to allow information/skills to stick.
  • It’s important to help build mental models. How do we address the space between a current mental model and a preferred mental model?
  • If we provide multiple learning structures within an experience we can promote flexibility for learners with different styles. The more options we give them, the more engaged they will be with the process.

In class, we made connects to Dirksen’s readings and parallels in terms of memory and attention. One point that stuck with me from this discussion:

  • How can we match a realistic emotional context within a learning experience? For example, when police officers or firefighters are being trained to deal with an emergency situation they need to be confronted with the same emotional state they might be in to be able to respond appropriately. In terms of UPMC, we need to consider what kind of state our learners will be in when we’re trying to facilitate a learning experience. How can we put ourselves in their shoes to better help? We need to consider the compromised state they might be in after during hospital care. Is that the best time to teach them?

Quadrants of learning

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  • Conscious competence: start to build up knowledge
  • Conscious incompetence: start to know what you don’t know
  • Unconscious incompetence: you’re a novice, you don’t know what you don’t know
  • Unconscious competence: expert knowledge (One issue here is “expert blind spot.” Experts may have issues working with novices.)

Those who are in the conscious incompetence quadrant are primed for learning. But, the space in which learning may be difficult is unconscious incompetence. How might we design something that helps novices learners realize what they do and don’t know?

We then moved into a class activity in which we were tasked to prototype solutions for a problem within the UPMC space. Our group chose to focus on how patients might become more engaged with their care process.

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Ideation / Prototype

Our prototype ended up being a way for children to engage with their own care process. In our specific scenario, Ashley was a young child admitted to the hospital because of an asthma attack. In order to educate and engage her in her care process, the hospital would give her an iPad with a digital game. This game would give her content about triggers to avoid (spores/pollen). our game definitely drew upon ideas of storytelling and roleplaying. It would be interesting to see how well this solution would apply to adults.

2/21 — Class 11

We had two guest lectures, Laura and Suzanne. Both are working on a study that involves elderly patients facing chronic heart conditions. The shared insights from their literature review, but could not share specific findings from their research. A few main takeaways:

  • Self-perception plays a big role in readmission. Patients who believe their illness stems from getting older/can’t be reversed as opposed to living an unhealthy lifestyle are less likely to stick with their treatment and improve.
  • Elderly patients may live alone and have to deal with the administrative complexities of post-care. These complexities include transportation, medical appointments, and filling medications.
  • The presence of misinformation on the internet contributes to declining patient health. If an elderly patient reads about treatment without checking in with their PCP, this may cause complications/decline in health.

2/26 — Class 12

We began this class by discussing readmission problem statements provided by UPMC. As we start to work on the readmission issue, it’s important to start framing the problem-space with a little more focus.

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Issues that emerged from the problem statement above:

  • Skills gap
  • Memory
  • Knowledge acquisition
  • Understanding the purpose/relevance of directions. This relates back to 4MAT structure where the why is being skipped over straight to into the what. Patients may be receiving information, but do not understand it’s purpose.
  • Issues with planning and organizing (shelves from Dirksen). 1) How information needs to be linked to things you’ve learned before and 2) how do you connect new information to things you’ve done before.
  • Competence and confidence
  • Expert vs. novice
  • Unconscious competence / conscious competence
  • Attention and motivation

6 Facets of Understanding

  1. Explanation: relate to other concepts
  2. Interpret: storytelling and how it translates or connects to something
  3. Apply: use knowledge in some way — active learning / can apply knowledge to specific situations
  4. Perspective: understand points of view / critical
  5. Empathy: grasp someone else’s perspective. Relate to another perspective
  6. Self-knowledge: knowing what you do and don’t know (conscious competence)

6 Facets Activity

We then got into our project groups to discuss how the 6 facets of understanding apply within the UPMC problem space.

We discussed a few potential spaces worth exploring until we landed on this question:

How might we get patients to become more active participants in their post-care process?

Here are the notes from our discussion:

Explain:

  1. Patients should be able to explain their exact care routine
  • Example: What meds they take, how many times a day they take them, how they use their weekly pill box

2. The purpose of their care routine

  • Why they take the meds they take
  • Understand this in the broader context of their lives. For example, how this care routine will help them transition back to more normal lives.

3. Be able to recognize when they are recovering/be able to track their progress over time (see & understand improvements).

4. Be able to understand for metrics like their blood pressure and what’s good/bad. And how this information informs their recovery process. Also, what to do in situations in which it’s worse.

Interpret

  1. Explain to others why they are doing what they are doing

Apply

  1. Applying medical care routine in different contexts. For example, someone may suggest that you eat something, but you know that it’s ultimately bad for your health and may contribute to readmission.
  2. Your doctor gives you a dietary guideline, but then you apply that within the context of your grocery store or when you visit a restaurant.

Perspective

  1. Patient support system: How do we get them to understand life from a patient’s perspective and why taking care post-discharge is important? And how they can help with that process?
  2. Patient: Understanding why they should communicate with their support system / decreasing guilty they may feel post-discharge for burdening their support system
  3. Understand doctors perspective: Goes hand in hand with understanding purpose — if you better understand the rationale behind why you’re taking certain meds you’re more inclined to take them. Doctors have different perspectives so giving patient’s visibility into that.

Empathy

  1. Patient support system: how to facilitate more empathy so that they can aid with the post-care process. Mimicking symptoms or burden a patient feels and getting a support system to feel that in some way (e.g., pregnancy belly for dad’s or family)
  2. Patient having more empathy for a doctor — could lead to a patient understanding rationale behind certain meds or med routine and how that will lead to a better lifestyle change long-term
  3. Patient community: giving a patient a point of reference and understanding that they are not the exception. Getting them to see other people’s stories provides greater context/visibility and perhaps motivation to take care of themselves.

Self-Knowledge

  1. Aware of how much they know/need to learn about their care process
  2. What is their competency/ability to implement their process or control themselves? For example, avoid bad habits that contribute to declining health (e.g., smoking)

Notes from our discussion:

  • Criteria — how do we asses patient’s on their understanding of these facets?
  • How do we gauge where they are as learners?
  • How can we facilitate personalized feedback based on our knowledge about where they are?

2/28 — Class 12

We began class by discussing our readings. The main takeaway from this discussion/readings is the idea of directed practice and feedback. We can give opportunities to learners that allow them to try things out and get some sort of feedback. Ambrose talks about targeted, goal-oriented feedback.

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  • Summative: more grade based
  • Formative: more progress/growth based
  • Feedback should be linked to what, where, and how
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We then discussed this idea that through several small challenges + feedback, learners can reach into higher level concepts (Gee image). Different levels teach different concepts, each one zooming out in scope. Small snippets are strung together to collectively reach a larger goal.

Activity

We broke off into groups to play two skill-building games — one physical and one digital.

Dirksen explains, “Expertise is formed in any area by repeated cycles of learners practicing skills until they are nearly automatic, then having those skills fail in ways that cause the learners to have to think again and learn anew. Then they practice this new skill set to an automatic level of mastery only to see it, too, eventually challenged.

Good games create and support the cycle of expertise, with cycles of extended practice, tests of mastery of that practice, then a new challenge, and then new extended practice. This is, in fact, part of what constitutes good pacing in a game (Gee 2004).”

We broke off into groups to play two skill-building games — one physical and one digital.

Dirksen explains, “Expertise is formed in any area by repeated cycles of learners practicing skills until they are nearly automatic, then having those skills fail in ways that cause the learners to have to think again and learn anew. Then they practice this new skill set to an automatic level of mastery only to see it, too, eventually challenged.

Good games create and support the cycle of expertise, with cycles of extended practice, tests of mastery of that practice, then a new challenge, and then new extended practice. This is, in fact, part of what constitutes good pacing in a game (Gee 2004).”

We started by playing Quibbler. It’s a bit of a rocky start as figuring out the rules (took us about 5 tries). Once we got our bearings, we had a ton of fun. The game involved vocabulary, spelling, and bluffing/poker face skills.

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We then played the digital game Kern Me.

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This game was really fun and engaging. The short, medium and long term benefits of the game were apparent. The game provided great in-the-moment-feedback and was directly related to improving kerning skills. As the game continued, our buy-in increased as did our motivation to do well.

3/5 — Class 13

During this class, we explored UPMC’s readmission issue individually and with partners.

Problem-space: What are you interested in studying or investigating moving forward? (Area of design, a theory of learning, or specific problem you’ve seen with readmission)

  • How to help patients maintain personalized care outside of the hospital
  • How to get patients to buy-in to their own personal care
  • Post-hospital care that’s personalized to a patient’s lifestyle
  • How can the hospital account for the social factors that influence a patient’s ability to take care of themselves after
  • How can we get buy-in from a patient’s support system? Or buy-in from a patient to allow their support system to be involved?
  • Can we leverage learning experiences with lifestyle coaches? Lifestyle coaches most involved with patients outside of the hospital/post-discharge.

Audience: Who do you anticipate being the core or secondary audience for the learning experience you are trying to create?

  • Patients: Specific patients within hospital space? Patients that are suffering from acute issues/need to help post-discharge or patients with manageable, but chronic illnesses.
  • Patients with an exhaustive medication list. Helping them remember their medications/reducing cognitive overload. During research, the clinical care workers asked a patient to discuss their specific medications, doses, and uses.
  • Patients that can change dietary habits?
  • Lifestyle coaches — core?
  • Support system — secondary?

Specific-problem: What is the problem you hope to address?

  • Patients that have medication routines post discharge
  • Patients understanding the value/purpose to taking their meds post-discharge
  • Patients understanding where they can get their meds post-discharge

Learning theories: What are the different learning theories you might leverage?

  • 4MAT system
  • Six facets of understanding
  • Defining learning experiences and bridging gaps
  • Attracting attention
  • Stages in the development of mastery
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Learning theories

Core: What will be the core knowledge acquisition and purpose of that knowledge (e.g., why is this important understanding from 4MAT)?

  • My idea revolved around the problem statements provided by UPMC and the issues that patients may not exactly understand why a care routine is important.

When/Where: When and where to engage your audience in a learning experience?

  • When: When care coordinators talk to a patient. Right before discharge/when care managers work with patients for a few days.
  • Where: when the patient is still in hospital after care has been administered (maybe not immediately post-care).

Other Notes:

  • Care coordinator intervention: Medication list form or info provided by the care coordinator when the coordinator works with the patient after critical care has been administered.
  • Lifestyle coach intervention: providing information at this checkpoint. Having a lifestyle coach might imply that a patient is better able or more committed to post-care maintenance. This is important because one issue that came from research is that it’s really up to a patient to drive discharge care. The hospital provides/connects a patient with the resources that it can, but it can’t necessarily go beyond that (e.g., to a patient’s home to make sure that they are no longer smoking). This is why patient buy-in is very important.

After brainstorming individually, we then broke off into pairs to discuss possible learning experiences.

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Notes from partner discussion

3/7— Class 14

During this class, we spent time thinking about our project’s focus. I spent some time discussing ideas with Stacie, Chen, and a few class members.

There are my brainstorming notes:

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Summarized Notes

Problem-space

Helping patients with newly diagnosed chronic but manageable illnesses manage care long-term.

Creating a system that supports these patients.

Main Questions:

  • How can we create a system that supports patients with the foresight that they might fail in caring for themselves?
  • How might we create a system that boosts a patient within and outside the hospital space? How do we help people recover from setbacks?
  • How can we create a patient support system with the foresight that patients may take a few tries to integrate their new care practices/routine into their life outside of the hospital?
  • How might we help them manage care long-term?
  • How do we design a learning experience that accounts for regression? Or that has the foresight that learners may fail at something?

Who are you designing the experience for? (specific learners and/or stakeholders)

Patients in their 30–50s who are newly diagnosed with chronic but manageable illnesses.

These patients may have already bought-in to their post-discharge care routine. How then do we help them stay motivated or feel supported outside of the hospital?

Most patients experiencing a shift in lifestyle will encounter some sort of setback. This support will need to take into account that a patient is going to be integrating new, long-term habits into their overall lifestyle.

What do you intend for them to learn (skills, knowledge)? What do you need to teach them?

Still pushing to define that “what.” The cycle of practice and feedback will be very helpful in helping define this further.

Why is it important for them to learn this? What is the value?

Can help patients better manage and feel support as they shift their lifestyle, integrate new habits, and change their behavior. It’s important that they feel supported through inevitable setbacks outside the hospital.

When do you foresee the experience taking place (doesn’t need to be specific time but rather a timeframe)?

This experience will reoccur during various points during moments within and outside the hospital (scaffolded learning, reinforcement).

  • Patient is diagnosed
  • During hospital stay
  • Discharge (touchpoints: doctors, clinical case managers, staff they encounter when checking out of hospital)
  • At home with caregivers

Where do you envision the experience taking place (describes the context, eludes to affordances, points to medium)

Within the hospital and outside the hospital

Important Methods:

Practice and feedback

Scaffolded learning

  • Questions to consider: Do patients need another persona to start? A caregiver? And do they eventually get to the point to the point where they are able to manage themselves with the system/device?

Next steps:

  • Continue pushing at the “what”
  • Propose ideas that would fit into the above components perhaps within in different contexts listed.

UPMC Passavent Visit

We met with 2 clinical case managers from UPMC Insurance working in UPMC Passavant Hospital.

Kristin:

  • Clinical case manager for UPMC insurance
  • Has 9 years of experience
  • Previously worked at Mercy hospital in Shadyside

Leslie:

  • Clinical case manager for UPMC insurance
  • 5.5 years of experience
  • Previously worked at UPMC’s hospital in Shadyside
  • Primary patient at Passavant hospital is older
  • Both clinical care case managers work with patients with UPMC Insurance — so they never really see issues with insurance
  • The mentioned that things do get a bit messy for patients with Medicare or medicate
  • Both see patients in the acute phase. They only work with patients for 3–4 days, might be as short as 40 minutes right before discharge.
  • The experience for post-discharge care is very subjective:
  • Every patient is different, and clinical care managers have to meet them where they are at
  • There are many social factors that contribute to a patient’s ability to maintain post-discharge care
  • Or, for example, change has to come from the patient. If a patient has COPD/been smoking for 20 years, they won’t stop immediately even if it’s critical to the health.

Support system:

  • Can’t advise support system directly without patient approvals and HIPPA compliance forms

Trust & doctors:

  • If patients believe in the care they are receiving, they’ll trust and be receptive to doctors recommendations

Still adding notes

Don Norman: Artifacts & People

This chapter is a chapter in Don Norman’s book Things that Make Us Smart. It deals with representation and fitting the artifact to the person.

A few notes:

Visibility

  • Surface
  • Internal (hidden)
  • Can apply this to the body /(EG X-ray competent to show how much body is getting — moving abstract to more concrete — making internal more apparent)

External representations of hidden / internal

  • Hanoi puzzle

Interesting discussion on graphical representations

How can we decrease cognitive load and surface info in the clearest more accessible way possible?

Think about the form that’s appropriate to the information trying to be communicated — clocks example. Want to know the precise time — digital is approbate. only need an approximation, then analog will do just fine

The physical design of objects/clues to their operation

Just as physical artifacts have characteristics that indicate use, cognitive artifacts do as well

Knowledge and information do not have shape or form

Digital media — easy to process and work with electronically / natural medium for computer system s-

  • The issue is making them feasible/understandable

Taking principles of physical objects and applying them to digital ones ]

We have a tendency to use objects in the more saliently perceived ways, not ways that are difficult to discover

Really interesting affordance discussion of television vs. newspaper

And how viewers/readers are paced

Appropriateness principle

Grudin’s Law

Written by

Interaction Designer | Carnegie Mellon University, School of Design | MDes ’21

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