Helping Healthcare Workers Persist in Online Learning: Lessons Learned

Many frontline healthcare workers, especially Certified Nurse Assistants (CNAs), would like to advance in their careers and enter a nursing program at their local college. Admission to programs is very competitive, however, and applicants typically need to complete challenging pre-requisite courses in writing, math, and sciences before they can even apply to a nursing program. One interesting option to prepare for college pre-requisites may be online learning contextualized around health careers and college success skills for workers reading at about the 8th grade level or above. Creating a learning environment that supports persistence for busy healthcare workers is challenging. Working with three local workforce investment boards, World Education created online courses for a project called the Health Care Learning Network. Here are some of the lessons we learned over the past four years.

Consider extended intake/orientation. Online learning is fairly new and many adults do not have a clear World Education, Inc.picture of the time commitment and self-discipline needed to make progress until they try it out. Providing a two-part face-to-face orientation in a computer lab, with 1-2 weeks between sessions, gave learners an opportunity to make sure they had the computer/Internet access and technical skills needed to log-in and navigate the first course. We also provided directions for all the basic activities (logging in, opening documents, etc.) in written format via a student notebook and in video format available from the homepage so that students had multiple formats for reviewing the skills taught during orientation.

Over time, we realized that workers found it difficult to turn down an educational opportunity proposed by their employer so some workers needed time to try out online learning and consider if this is the right time and mode of learning for them. And, it helps to develop a graceful way to exit for those who find online learning isn’t a good fit.

Consider a hybrid format and adjust, as needed. At any given time, perhaps 10 percent of our students would zip along, completing assignments and lessons in their courses without need for further face-to-face contact. Most students, however, needed the external motivation of face-to-face gatherings in order to persist. We called these gatherings “Learning Labs.” Typically, they were three hours long. Initially, the first hour was set aside to give students time to gather and work on their current course with one-to-one tutoring from their instructor, if needed. The remaining two hours were divided between group activities to build motivation and college awareness. As time went on, we found that making progress on course work was the most motivating activity for students. In our final format, students would spend up to two and a half hours working on their course with the instructor who was available to answer questions. The final half hour was group time.

Interestingly, offering weekly face-to-face sessions did not turn out to be productive. Most students could not set aside face-to-face time each week. Since many students had every other weekend off, Saturday Learning Labs were fairly successful, if students could coordinate their schedule.

Consider anytime/anywhere supports for online students. While face-to-face meetings are important, to be a truly successful online learner, students needed to be able to connect with their instructor by email and telephone. Our courses are self-paced but facilitated with an instructor following student progress, correcting exams and other assignments. Between orientation day one and day two, the instructor set up a time to talk with new students by telephone and email to cement those communication options. After that, the instructor continued their outreach via email and calls to the student. Many students needed to be explicitly taught to return telephone calls and emails. And, we found, lack of communication could have one of several possible meanings: disinterest in the program, embarrassment at not logging on to the course regularly, unanswered questions about an assignment, loss of Internet access, and personal or family illness to name a few. Connection to the student’s workplace via a career or educational coach was extremely helpful in identifying the problem so that it could be addressed.

Consider a contextualized curriculum. One of the biggest motivators for frontline workers, especially English language learners, was the health contextualized curriculum. Our program offered four courses: Computers for College, Basic Math Review, Reading and Writing for Health Careers, and Health Science. Content and activities introduced technical and academic vocabulary and key concepts and study strategies so that students would have some familiarity with them before entering fast-paced college courses. Assignments and exams were designed to demonstrate mastery of both health concepts and study strategies before a student moved on to the next lesson or course. One of the most important areas of learning for students was around the use of the computer and Internet for college – using a word processing program, attaching documents, organizing a focused web search, vetting websites, and summarizing information rather than copying it into assignments and reports.

More persistence strategies needed. All of these strategies help but we’re not there yet. About 10% of our frontline workers find contextualized online learning is just what they need. For these students, courses serve as a brush-up and the experience gives them confidence to apply to and enter college. In fact, these students tend to enter college before finishing all four courses. Most workers are able to complete Computers for College, gaining useful skills with technology that is of interest to virtually everyone that enters the program. For English language learners, these online courses provide a format where students can go at their own pace, retake lessons, and use audio resources, as needed. These students tend to work very slowly but eventually finish courses. In one pilot, adult education students in transition-to-college programs had good success using just one online course, the Health Science course, as part of their face-to-face program for students interested in entering a college health career program. Presently, a small number of adult education centers are piloting courses in conjunction with weekly face-to-face classes and this emerging model is moving students along more quickly and with greater success.

Ed. Note: Cynthia Zafft wishes to give special thanks to her HCLN colleagues, Sally Waldron and Steve Quann, for their suggestions for this article.