Pivoting to Online Learning: Designs for Learning Efficiency

AO NA's Chief Learning Officer, Chitra Subramaniam, PhD, discusses applying evidence-based learning strategies to online medical education

21 January 2021

The COVID-19 situation has challenged us to think innovatively about reaching out to our learners and engaging them in the process of learning that we are all passionate about. Many organizations, universities and other education providers are pivoting to online delivery very quickly. AO North America is no different. 

I want to share my utmost gratitude and heartfelt thank you to all the faculty who took the chance and are helping establish our online footprint.  Questions that I am trying to answer are: Is there going to be a new norm? Is learning going to be different? What is the new normal going to look like? I am sure all of you are probably asking the same questions. While we wait to see what happens, I wanted to write about something that might be useful to you as you are all involved in teaching online and are virtual faculty.

Researchers have made significant advances in studying the application of cognitive processes to learning (Weinstein, Madan & Sumeracki 2018). These studies have provided us with several teaching strategies that help to maximize learning efficiency. These strategies are applicable to both face to face and online learning. For now, lets think about how they apply to online learning.

Learning strategies to maximize efficiency

  • Spaced practice


    Several research studies that support creating a schedule for continuous learning that spreads out over a period. Key concepts delivered with multiple developmental milestones delivered over a period of time. The advantage for memory is greater. Repetitions spaced over time lead to greater retention than the same number of repetitions close together. It promotes deep learning and retention.


    Weekly, bi-weekly or monthly recurrence of topics and discussions rather than massing or cramming all together at one time.

  • Interleaving


    Taking ideas and concepts and mixing them up or switching between ideas and changing the sequence or order in which they appear over time. 


    Present a concept and discuss three different case examples or switch between worked out/solved examples and those that the learner needs to solve in one session. When you summarize or reinforce the concepts, relate and link back to the case study examples in a different sequence from how they were originally presented.

  • Elaboration


    Process of adding features to one’s memory.  For understanding to happen, new information needs to be connected to pre-existing knowledge. Promotes deep learning.


    Elaborative interrogation: small group discussions that highlight the why and how questions and responses.  Concrete case studies, examples and sharing of experiences help elaborate a concept and its meaning. Presentation of the same concept and its application in different formats—visuals, video, and other media after it is once shared. Allowing learners to answer questions during an online session, present solutions and self-explain strategies that helped solve the problem or the concept of self-explanation.

  • Concrete examples


    Reinforcing concepts or principles with multiple examples.


    Novices in contrast to experts focus more on the surface details in examples. Experts can extract underlying problems and stay focused on them. Thus, multiple different representations of the same concept are essential for learners. It is, however, the instructor’s role to make the connection explicit for the learner. Thus, the need to use the right examples, case studies and challenges for the right group of learners at the right time!

  • Dual coding


    When text is combined with visuals, our learning is enhanced since text and visuals are processed through separate channels and there are two ways of remembering the information later.


    Text descriptions with relevant images. Images with labels that describe different parts of the image. Visual cues on images to focus the learner.  Procedural videos (with no audio) with text annotations.

  • Reinforcement (retrieval practice)


    Bringing information to mind from memory to support long term learning.


    Review of what was previous learned; assignments, activities, and tests that help retrieve and apply concepts. Online discussion forums to promote retrieval and application of concepts. Provide feedback.

Table adapted from Yana, Weinstein and Sumeracki (2019): Understanding How we Learn.

It’s not a lecture online. It’s an active learning session online. The packaging of the content to allow for interactions and the effective use of technology to promote some of the above principles and augment the learning is key. Also, when you are in cyberspace you feel isolated though you are with your learners (in synchronous settings) because you cannot see them. That presents a challenge. But chats, question and answers, group discussions, opportunities for learners to self- explain create the interaction needed.

  • Engage with learners. Sessions need to be dynamic, to encourage interactions, comments and collaboration with co-faculty to drive concepts
  • Create a supportive environment. Do your check-ins after every ten minutes, let the conversation flow well and do not be too prescriptive. Recognize challenges and difficulties and respond to questions with the help of moderators.
  • Use a mix of learning tools. Make the interaction dynamic: audio, video, tools, additional resources, discussions, and other complementary interactions will help.
  • Provide ongoing feedback. Responses to assignments, coaching sessions, access to experts.
  • Make content mobile. Bite-size chunks of content easily accessible through different devices that can be easily digested.

Even when learning in the virtual world, it would be important to stay connected to the deep smarts: those who have built up technical, professional and business expertise through years of experience, which makes them wise, think critically, make swift decisions and effectively problem solve. Deep smarts do not just have facts and data that one can access, they have know-how—skilled ways of thinking and associated behaviors that consistently lead to success.

Learners need to take every opportunity to identify such deep smarts and pull knowledge from them, be open to mentoring, receiving feedback and reaching out frequently to access the expertise available to them. Expert panels, virtual coaching and mentoring are key to the success of online learning as well. 

Food for thought: How do you learn and make yourself an expert? What helps build such deep smarts?

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