Health Education England established a Technology Enhanced Learning programme to deliver the most effective education and training through evidence-based technologies.

Healthcare education is a complex and costly business, seemingly ever at risk from financial and technological disruption, and needing a coordinated, responsive and innovative system of delivery. To meet this need, Health Education England (HEE) was established as the executive public body responsible for the leadership and the coordination of healthcare education. Its mission is to provide the right workforce, with the right skills and values, in the right place at the right time to better meet the needs of patients - now and in the future.

Simulation-based education includes various techniques to enable health and care staff to practice and learn in a safe environment. All images: Health Education England/NHS.
Simulation-based education includes various techniques to enable health and care staff to practice and learn in a safe environment. All images: Health Education England/NHS.

The healthcare education landscape has changed dramatically in recent years due, at least in part, to advances in technology-based learning resources, such as simulation and digital learning applications. To help make the most of these advances, HEE established a Technology Enhanced Learning (TEL) programme, whose purpose is to deliver education and training that capitalises on a wide range of effective, evidence-based technologies.

The TEL programme has a vision that patients and the public in England benefit from a health and care workforce educated using the most effective evidence-based informed technology and techniques.

The three key areas of work within the TEL programme are:

  • The development and delivery of digital learning resources
  • Support and guidance for simulation-based education
  • Horizon scanning, innovation and piloting of new technology and techniques.

Further information on the TEL programme can be found here or by following @HEE_TEL.

HEE e-LfH e-learning programmes are accessed 24/7 from a variety of locations and devices.

e-Learning for Healthcare

The central pillar of the TEL programme is e-Learning for Healthcare (e-LfH). This is a programme that develops and curates e-learning resources, and delivers them from its own platform, free of charge, directly to the entire health and care workforce in the UK, (approximately 3 million workers). The online sessions enhance traditional learning, support existing teaching methods and provide a valuable reference point. The programme has over ten years of expertise and experience of collaborative working with health and care partners. There are now over 10,000 individual learning sessions available on the platform. E-LfH provides the health and care workforce with:

  • Free access to high quality on-line learning resources 24 hours a day, seven days a week.
  • Resources which are developed with experts and validated by appropriate bodies such as Medical Royal Colleges;
  • Multiple routes of access to learning through local and national systems and personal electronic devices;
  • Innovative learning methods to enhance the learning experience;
  • Recording and recognition of learning activity for use in e-portfolios and learning management systems.

In 2017 there were over three million e-learning sessions completed, (about 11,000 per day), demonstrating the strength and the value of the programme for the health and care workforce. 2018 is shaping up to be an even bigger year, with the number of completions expected to top 5 million. For more information visit.

The Learning Solution

Technology enhanced education in the form of, for example, simulation techniques, mobile applications, video or virtual reality is now widely used to deliver teaching and learning in health and care. However, the development of learning resources at a local level has been largely un-coordinated. In addition, there has been a reluctance to share expertise across sectors, leading to unnecessary duplication and expense. We have also found widespread evidence that significant learning takes place outside of formal learning environments, through informal learning activities such as blogs, social media and discussion groups. These informal and crowdsourced resources form a major part of an individual’s learning these days and are frequently used for just-in-time/rapid learning interventions.

In an attempt to improve support to learners, the TEL programme carried out an extensive research exercise including desk studies, workshops and surveys, and in doing so identified the need for a national ‘learning solution’ which would give commissioners, educators and learners ready access to thousands of formal, informal technology-based resources, as well as ideas and work in progress.

The “Learning Solution” is in beta development with a publicly accessible version due for release in summer 2019. It will be a digital service to help everyone involved in healthcare education share and discover TEL resources, as well as the platform where learners will access our existing e-LfH programmes. Creators will be able to post their work on the site and share with others; whilst those looking for material will be able to search for and locate what they are seeking, easily and efficiently. The resources will either be hosted directly on the Learning Solution platform itself, or signposted to other affiliated sites. The interactive and collective design of the Learning Solution site will, of course, offer opportunities for feedback, collaboration and innovation and bring together a wide range of communities of practice.

Features being planned include:

  • A platform for users to find, share, access and collaborate on learning resources in all formats;
  • A full record of learning activity, whether formal or informal, online or face-to-face;
  • A ratings and review system directing users towards the best resources;
  • A place for communities of practice to develop and flourish;
  • Potential for an ‘invisible LMS’, where users can interact with the system using chatbots accessed through messaging apps like Skype or Slack, allowing users to find and access learning resources without opening a browser or logging in to the Learning Solution;
  • Potential for an AI driven recommendation engine which will personalise the learning experience for every user.

HEE’s digital literacy domains
HEE’s digital literacy domains

Building a Digitally Ready Workforce

To achieve the real potential of technology and harness it for the benefit of individuals, everyone working in health and care must be confident and competent in the use of digital and other technologies. HEE defines digital literacy as: “Those capabilities that fit someone for living, working, learning, participating and thriving in a digital society.” Developing the digital capabilities of all staff has led us to develop a framework that describes the type of digital capabilities that are needed.

For the full digital capabilities framework go to www.hee.nhs.uk/our-work/digital-literacy.

The Building a Digital Ready Workforce Programme is responsible for building the necessary digital capabilities across the health and care workforce. The programme focuses on the digital literacy of all staff; it also builds specific leadership skills in digital transformation and develops and utilises the professionalism of those dealing with data and information.

Recently the Digital Academy has been founded, providing an academic programme in digital leadership. The Faculty of Clinical Informatics has also been established and exists now as the professional membership body for all clinical informaticians.

The five principles of HEE’s simulation-based education framework
The five principles of HEE’s simulation-based education framework

National Framework for Simulation-based Education

Recent years have seen an upsurge in the use of simulation-based education (SBE) in healthcare which, for some of the reasons described above, has not always delivered against the requirements of Department of Health TEL Framework (DH 2011). It was recognised that there is a need for an updated framework that defines the vision and expectations for a national approach to the delivery of SBE across England. The redrawn framework supports the development and commissioning of SBE, and in turn, will help shape policy and strategy, leading to a continual circular process that is quality assured, transparent and robust.

The framework will:

  • Encourage provision of high quality, educationally coherent SBE;
  • Provide patient-centred, service driven SBE, enabling workforce development and transformation;
  • Ensure equity of access across all sectors and geographic regions;
  • Support commissioning and provide value for money;
  • Promote collaboration and sharing of resources;
  • Promote and encourage innovation.

Virtual Reality and Augmented Reality

In the course of developing the framework, some important relationships were developed with experts in the fields of Virtual Reality (VR) and Augmented Reality (AR). HEE has worked with experts to develop a healthcare VR Lab. This VR Lab offers a practical space where clinicians, staff and patients can experience and engage with the technology first hand in order to gain an understanding for themselves of its capabilities and limitations.

•          360 video recording in simulation-based teaching sessions

By using virtual reality filming through a 360-degree video camera the whole simulated environment is captured. The facilitator and participants have access to a recording of the complete environment and any activity that otherwise would be missed by fixed cameras.

This allows the teaching to focus more effectively on important interactions that may occur in the otherwise unseen spaces of the room.

•          Paediatric VR day surgery intervention for anxiety reduction

This project utilises virtual reality and 360 video as an educational tool for children and young people to understand, see and virtually interact with the clinical environment before they undergo a surgical procedure, in order to reduce their anxiety.

•          PatientVR

The purpose of this project is to display immersive 360-degree visual content from the patient perspective. By allowing the clinician to ‘virtually’ see through the eyes of the patient, an opportunity is provided for reflecting on environments, care, communication and patient generated triggers. This has a positive impact on the promotion of non-technical or human skills required in healthcare. Staff report developing more awareness of the importance that these ‘soft skills’ have for the patient and for their own professional practice.

Horizon Scanning

Our horizon scanning project explores the opportunities, implications and readiness of the latest or emerging technologies and considers their relevance to education and training in health and care. We consider the likely impact of new technologies and explore what the future of technology enhanced learning in healthcare might be like.

We have run workshop activities, both online and face to face, including hackathons, to help generate creative ideas about the future of  TEL in healthcare. Our ‘future view personas’ were created by clinicians, industry experts and “healthtech” entrepreneurs to help us envision how healthcare workers might be using technology to learn in 2021. This foresight activity generates new areas of exploration for the TEL programme; informing investment decision and research. Recent projects include piloting the use of artificial intelligence (AI) for digital competency assessment and establishing the Virtual Reality Lab to carry out research into the utility of different devices and software for healthcare education and to grow a ‘VR in Healthcare’ community to spread learning.

Virtual reality is being used throughout healthcare education.
Virtual reality is being used throughout healthcare education.

Pilots and Innovation

Part of future scanning, TEL are working on a number of small-scale projects exploring the benefits of new technologies to support education and training in health and care. These small-scale projects will increase the likelihood and the speed with which HEE and partners are able to derive benefits from the latest and emerging technologies.

Case Studies: Artificial Intelligence

  1. We are carrying out an AI experiment using a tool to assess an individual’s digital capabilities against the HEE digital capability framework and then makes recommendations on the most appropriate resources to support that learner’s need. The learner interacts with a chatbot interface to perform the assessment and an AI-curated list of resources is presented to the learner in priority order of their learning need. Health and care learners are being introduced to the tool at the moment, and the study will conclude at the end of December 2018 when the preliminary results will be presented.
  2. We are working with the Leeds Institute for Medical Education on a second AI experiment that uses natural language processing algorithms to assess the personality types and thinking styles of undergraduate medical and nursing students, which it does by analysing their responses to a trigger photograph (e.g. an image of a sunset over a beach). This information is then used to provide learning prompts for learners and to inform tutors about tailoring support mechanisms specifically to an individual and their learning style, which also concludes at the end of December.

These studies will hopefully provide valuable research into the power of AI in education and training.

Summary

Despite the continually evolving landscape and complexity of healthcare training, it is possible to say with certainty that the role of technology will only continue to increase. HEE acknowledge this and that there are huge benefits to the learner and ultimately the patient that can be achieved through leveraging the right technology and related techniques. Such technology enhanced learning approaches will ultimately be able to enhance the country’s capability to deliver the workforce transformation required to meet future healthcare demand. The ultimate purpose is to support the most valuable assets in the delivery of healthcare; its workforce. 

About the Authors

Chris Munsch is a cardiac surgeon at the Yorkshire Heart Centre in Leeds. He has interests in surgical training and medical education, in particular simulation and technology enhanced learning. He is part of the HEE TEL programme, by providing clinical advice and leadership.

Dr Neil Ralph is the National Programme Lead for TEL at Health Education England; where he also leads on a range of other national programmes. Neil has always had an interest in technology and its impact in healthcare and education. He is also a clinical psychologist with experience of working clinically and in academia.

Originally published in Issue 4, 2018 of MT Magazine.