Have you ever been in a training where you feel a little bit like Charlie Brown when he is in his classroom? Where your attention everywhere BUT on the topic at hand?
Maybe what the presenter said was disconnected with your own reality (a la The Office)?
Or, maybe, just maybe, you jumped into a lecture that was above your head, your pay grade, or understanding? (this video has always been a favorite–glad I have the chance to throw it in here!)
You have been in those situations. We all have been. As a trainer, I like to cue up a lesson to make sure that the stage is set, learners are ready, and that they know what the point of the instruction is. In order to cue up a lesson, I remind myself of the first three, of nine, events of instruction.
Robert Gagne famously (ok, “famously” in certain circles) outlined nine events that codify learning and instruction. The events simplified and explained what was thought to be “good instruction”.
Let’s look at the first three:
- Gain attention to ground the lesson and to motivate learners
- Describe the learning goal and what will be accomplished by the lesson and how it relates to work/tasks/desired outcomes
- Stimulate recall of prior knowledge
It should only take a few minutes to move through all three of the primers. For example, by asking about a problem and how the participants view that problem, you can easily accomplish number one and three. By drawing on the past experiences of participants you can touch on point number three.
I recently wrote training materials for health care workers who were being asked to switch up the treatments that their patients were taking. The activity below was meant to build empathy for the patients, describe a bit of what we’d be learning, and help the participants to consider how medications were currently being prescribed and the challenges patients face…
Activity
· This activity is intended to inspire an empathetic response among participants to the adherence challenges that their patients face.
Say:
· As we mentioned in the beginning, we are going to give you opportunities to try to put yourselves in the shoes of your patients.
· Let us do a short demonstration now to start our discussion on adherence. This demonstration will help us to start thinking about some of the reasons for poor adherence.
Do:
· Ask for three participants to volunteer for this demonstration.
· Each of the three demonstrations will be slightly different. Please read the instructions before facilitating the activity.
· Demonstration One:
· Hand the first participant volunteer two bowls. One bowl should be empty. The second bowl should have 50 or so small candies in it.
· Tell the participant that he or she has exactly 30 seconds to transfer exactly 30 candies, one-by-one, from the full bowl to the empty bowl. The participant should aim to put the 30th candy in the bowl at the 30-second mark.
· Do not count down the time or indicate in any way that time is passing.
· At the end of the 30 seconds, stop the participant and ask the participant to count how many candies they transferred to the empty bowl.
· Ask the participant:
· How might this demonstration be like taking ARVs?
Answer:
· Patients take ARVs at specific intervals
· A specific number
· Regulated, etc.
· How did it feel to not understand why you were doing this task? Did you think that this activity might be pointless?
· How might patients feel about taking ARVs when they feel perfectly healthy?
· Demonstration Two:
· Hand the second participant volunteer the same two bowls. One bowl should be empty. This time, the second bowl should only have 20 or so candies in it.
· Tell the participant that he or she has exactly 30 seconds to transfer exactly 30 candies, one-by-one, from the full bowl to the empty bowl.
· Do not count down the time or indicate in any way that time is passing.
· At the end of the 30 seconds, ask the participant to count how many candies they transferred to the empty bowl.
· Ask the participant:
· How did it feel to be unsuccessful with such a simple task?
· How did it feel when you knew you did not have the 30 candies that I asked you to move?
· How might this demonstration relate to patient challenges with ARVs?
· Demonstration Three:
· Hand the third participant volunteer one empty bowl. This time, you, the facilitator, should hold the second bowl with 50 or so candies in it.
· Tell the participant that he or she has exactly 30 seconds to transfer exactly 30 candies from the full bowl to the empty bowl.
· This time, though, the participant must ask you for three candies at a time. You must hand the participant three candies and he or she will deposit them one-by-one into the empty bowl. Feel free to delay the hand off, give two instead of three, and otherwise make the activity more challenging.
· Do not count down the time or indicate in any way that time is passing.
· At the end of the 30 seconds, ask the participant to count how many candies they transferred to the empty bowl.
· Ask the participant:
· How might this demonstration be like taking ARVs?
· How did it feel to know that you had to ask for candies often enough that it kept you from reaching your objective?
· How might this demonstration relate to how clinics and patients interact?
Answer:
· Clinics do not always work according to the schedule or needs of the patient.
Ask:
· Why do you think we did this activity?
· Do you think that we, as providers, are aware of all of the challenges that patients have with adherence?
· What challenges came up in this activity?
Answer:
· Keeping to a schedule
· Stock-outs
· Conflicts between clinic and patient need, etc.
Say:
· In many cases, patients may not understand why they are taking their medications, just as in the first demonstration. Plus, the idea of taking drugs while still well is a new idea that many people do not understand.
· We also know that health systems are not always in sync with what a patient may need in terms of clinic hours or amounts of medication that they can be prescribed at a time, and so on.
As you can see, this brief activity, designed to take no more than five minutes or so, accomplishes the first three principles of good instruction. It grounds the participants. They are ready to learn, captivated by the exercise and they are linking what they are seeing to past experiences with patient adherence and, finally, they get a sense of what the lesson will be about.
I often write curricula that other people will deliver. Sometimes, I get push back around activities and cue-up questions as trainers sometimes want to rush to “get to the point”. I write these segues and lead-ins as deliberate elements of the training and a part of how I design the instruction. When learners can’t connect to new or unfamiliar content, the new concepts will become “slippery” and not stick. The next thing you know, you are Charlie Browns teacher.
What are some of your favorite cue-up activities or questions? How do you make sure you are incorporating these nine events of instruction?
PS: You can find the entire OPTIMIZE curriculum on the ICAP website and my review of the work here.