When Training Feels Easy, It May Not Be Working

By Matt Hays, Ph.D., SVP, Research & Analytics for Amplifire

Healthcare organizations invest enormous amounts of time and money in training. At the end of most training experiences, learners are asked how much they liked it or whether they believe it will be useful in their day-to-day work. Learners tend to base their responses on how dynamic the trainer was and how rapidly it felt like they were learning the material. When smile scores look good, learners and educators alike assume the training worked.

Unfortunately, you can’t feel when you’re learning. You can only feel how you’re performing during learning. And the two are not always the same; learning can feel good without being good. In fact, a learning experience that feels particularly easy is a lot like a workout where you don’t break a sweat; it probably isn't doing much for your long-term goals.

Learning Should Require Some Work

On the other hand, some of the most effective learning strategies make the experience harder, not easier.

Consider the difference between re-reading information and retrieving it. Re-reading a clinical guideline is easy. When you get to the end, you’ll probably feel like you didn’t need to read it at all because you know it so well. If, instead, you tried to recall the guideline from memory while applying it to a patient scenario, the task would be harder.

That difficulty has value; it is desirable. UCLA Professor Robert Bjork coined the phrase “desirable difficulties” to describe learning strategies that challenge the learner but, as the learner overcomes those challenges, create more durable, transferable learning. Retrieving instead of re-reading, waiting for corrective feedback, and spreading your learning out over time: all of these reinforce knowledge, skills, and abilities.

Not all difficulties are desirable; you wouldn’t want to work out with a two-ton dumbbell. And you wouldn’t want to lift weights in order to get better at making a differential diagnosis. The value of difficult training emerges when the challenge can be overcome and when overcoming it aligns with the goal of enabling clinicians to retrieve and correctly apply the appropriate knowledge in a particular situation.

The Greater Risk May Be What We Think We Know

For patient outcomes, physicians’ confidence may be more important than their knowledge. An uncertain clinician may consult a colleague or check a reference. But when a clinician is sure they’re right, they have little reason to stop and verify their beliefs. They simply act. If they’re wrong, that action is a mistake; their Confidently Held Misinformation™ can cause errors, near misses, and unnecessary pressure on the safety systems designed to protect patients.

As a result, effective training needs to be more than just one-size-fits-none information delivery. It needs to uncover learners’ misconceptions, especially when they’re confidently held.

One way to do that is to ask questions at the start of a training session and have learners rate their confidence in their responses. Trainers can identify what someone doesn’t know and the subset they’re sure they do.

Measure What Matters After the Training Ends

Asking questions is usually reserved for the end of training and is a common way to evaluate training efficacy. But an immediate post-test only asks a learner to repeat what the trainer just said and gives no clue about how long the training will last.

It’s also common to ask training-satisfaction questions. That has its place, but whether someone enjoyed a course tells us very little about whether the learning will change behavior.

It’s even more common to mark someone as “trained” if they completed the training, which can require as little as sitting in the same room as a PowerPoint presentation.

What we really want to know is whether the learner can retrieve and apply what they need when they need it. And so the measure of training success needs to tie back to the reason the training was done in the first place. For example, if training was designed to reduce patient falls, we should look at whether the number of falls decreased after the training rolled out sitewide. We could also look at indicators of process improvements (e.g., a post-training decrease in the count of glossy magazines found on the floor in patients’ rooms).

That shifts the conversation from “Did employees complete the training?” to “Did the training change what happens in practice?”

Healthcare does not need clinicians who are simply good at completing training. It needs clinicians who can access and apply the right knowledge when it matters. It’s harder to measure, but that difficulty is desirable.

---