CME: the first step is understanding how we learn

Rebecca Aris interviews Dr Jonas Nordquist

Karolinska Institutet

We interview Dr Jonas Nordquist of the Karolinska Institutet on how to improve the quality of education by better understanding how we learn in the content of CME-CPD events.

Plenary sessions, breakout groups and patient role play – sound familiar? CME-CPD events don’t necessarily need to follow the default model, but without an understanding of the latest research into how we learn – how can educators think outside the box when designing a CME-CPD event?

We interview Dr Jonas Nordquist of the Karolinska Institutet whose role is to improve the quality of education by better understanding how we learn. We discuss this in the context of CME-CPD and how we can better plan CME-CPD events with the latest understanding of how adult learning occurs in mind.

Dr Nordquist highlights the importance of making learning visible and how to find appropriate teaching and learning methods to reach the aims and objectives of a CME-CPD event.

Interview summary

RA: Thank you for agreeing to take part today. Could you explain to me a bit about your work at the Karolinska Institutet?

JN: Karolinska Institutet is an international bio-medical research university. Our mission is to improve people’s health through research and education. I’m the director of the medical case centre, and I am a medical educationalist. My overall role at KI is to improve quality of education, and we do that basically in three ways, method development, particular developing and designing medical cases, educational leadership development and the development of physical learning spaces such as s interactive classrooms and informal learning environments.

RA: What are the most important things you’ve noted when working on educational initiatives?

JN: There are few things that are absolutely critical for student learning or for student achievements, which are backed by excellent research. Most of the things we do are not opinion driven, but they are based on solid evidence and research.

The first thing is that you have to make learning visible. What I mean by that is that the professor or person running an educational activity has to understand what the expected learning outcomes are, as do the participants in the meeting. In many instances the experts are normally content focused, and they speak about expertise and not what the audience ought to be able to do with that particular knowledge when they leave the learning activity.


“There are few things that are absolutely critical for student learning or for student achievements.”


The second thing is that when you are active in participating in your learning process there’s a more favourable outcome than to being passive.

The third thing is that there’s really not one best method when it comes to teaching undergraduate students, post graduate or CME-CPD. Sometimes we look for a golden bullet or a method that will solve all those problems, but it doesn’t exist. What you have to do is to find a proper balance of different educational methods.

RA: Can you tell us more about how learning occurs?

JN: When adults enter a learning situation of any kind, they are not an empty vessel. As adult learners coming in to any new learning situation we have a lot of prior knowledge and previous experience connected to that. It doesn’t mean that we have it right, but we do have a previous understanding or previous experience of something.

There are a few things that are absolutely critical in this regard. The first is that an adult learner has to understand how and why the topic is relevant to what they do in their professional life. This knowledge is absolutely critical.

The second thing is that in the meeting between existing and new information there is a negotiation of what you have to bring with you when you come in to the learning situation and the new information that is transferred during the meeting. It’s like a negotiation really between the new and the old. Out of that negotiation comes a new, better and deeper understanding.


“…an adult learner has to understand how and why the topic or conference is relevant to what they do in their professional life.”


RA: How do you think educators can best get their messages across at a CME-CPD event?

JN: First of all most universities, and the educational sector used to be defined in an era of industrialisation, and back then what people needed to know was to read, write and to calculate. That was enough, because a lot of the work was done in a manual skilled based way. Work today is much more about solving complex problems and applying it in a more theoretical way and we have to find better methods in order to train for that. So from an educator perspective I think that what one has to do is to think carefully about a few things.

First of all you have to be very conscious of active design when you design a CME-CPD event, it is of tremendous importance.

Secondly, you have to be very clear about the overall aim of any event. I go to many CME-CPD events internationally every year, and tend to find that there’s a strong focus on the content but you lose what the educational objectives are and what the learner should be able to do with that information when he or she comes back to his or her daily practice . Clarification of the overarching aim and learning objectives is very important.

It’s also important to remember that there’s a risk, which I would call the risk of default or the risk of rituals. The risk of default is a default mode you fall into when you set up a meeting – you have plenaries, debates, breakout groups, you might have a patient case. You do that because that is what is expected and this is what a CME-CPD event normally looks. However, when doing it in a default way you don’t put that careful consideration into it that you need to make it a high-quality learning event. And a fun event to attend!

There’s a lot of research out there in the area of learning that you can very easily incorporate into actively designing a meeting.


“When adults enter a learning situation of any kind, they are not an empty vessel.”


RA: How can education providers think more carefully around the decisions they make when organising a CME-CPD event?

JN: First of all, again, the notion of understanding active design of meetings is very important. What I tend to see at many CME-CPD events are two or three types of activities.

One would be the plenaries, where experts deliver the latest findings in a specific therapeutic area. The problem with these is that they are can be overloaded with information as in PowerPoints. After a while it can get quite boring listening to one speaker after another. So many educational planners then plan breakout groups.

Breakouts are normally smaller groups of people that come together in small rooms. But since the education objectives of a breakout group is not normally totally clear for everyone, the breakout group becomes a mini lecture. In addition, the Q and A that sometimes occurs becomes rather dull and boring.

The problem here is with the active design, you have to think very carefully about what the difference is between a plenary and a breakout group, and how can you communicate both to the participants as well as to the organisers and the facilitators exactly what the outcomes is expected to become of a breakout group.

In many meetings you tend to see electronic voting systems, the clickers, which have become a ritualistic remedy in plenary sessions. They tend to be used with a patient case example. The audience is given the patient history and is asked to vote on possible diagnosis and treatment. The problem with this is that the patient cases are usually too short and are not normally too complex. There is no consideration of any deeper level – you just take a vote, they might have an entertainment value, but from an educationalist perspective it doesn’t have a very strong value for learning as such.

Education providers can design events using the before mentioned activities, but active design in important where you clearly differentiate between the activities, and you demonstrate a clear difference of what these activities are supposed to do in relation to the overarching aim and objectives of the meeting.


“…you don’t put that careful consideration into it that you need to make it a high-quality learning event.”


RA: Finally, what is your key take home message when thinking about learning activities?

JN: Have active design of the meeting, make the expected learning outcomes visible to the participants, and you need to have a variety of different activities.

I have no real criticism at the individual activities that I have mentioned, however, you have to think more deeply about them and in a more learning-centric way to improve how you connect them together.

What we do at the medical case centre where I work is three things. Firstly we work very closely with the development of patient cases. We have been working with undergraduate education as well as post graduate training and CME-CPD, it offers another mindset and we try a little bit more thinking in order to make these things work.

The second thing we do is training education leaders to become education leaders. A lot of being an education leader is about understanding the design of meetings, and design of different education activities. How those different activities are going to play together requires a level of strategic thinking from the education leaders.

The third thing we do is work with the physical design of learning facilities, and that also has a very high relevance for setting up education meetings at any hotel. How do you set up the room, how do you orchestrate the room, and where are people going to be seated, and how would that influence the level of interaction you want to have within the meeting as such? This all helps to facilitate high quality learning.

It would be very sad if medical education and CME stayed in a very old fashioned passive way of learning. What benefit would it be for pharma sponsoring an educational event, if you design a meeting that is passive, which we know leads to low quality learning?

RA: Dr Nordquist thank you very much for your time and the really interesting messages you had there.


About the interviewee:

Dr Jonas Nordquist has been the Director of Karolinska Institutet’s Medical Case Centre since 2005 and the associate director of residency programs at the Karolinska University Hospital, in Stockholm, Sweden. He is also a Harvard-Macy Scholar at the Harvard Medical School. He is the founding course director of Leading for Change, and educational leadership program that is run together with BMJ. Dr. Nordquist has been working with educational initiatives in several countries including the United States, Taiwan, Hong Kong, Ethiopia, Uganda, Mozambique, South Africa, Malaysia, Guatemala, United Arab Emirates and Canada.

Dr Nordquist began teaching during his doctoral studies in political science, which led to a scholarly interest in pedagogics and adult education. He previously worked in the Swedish Parliament, the National Ministry of Justice and the National Ministry of Public Administration. He was also the director for educational development at the National Swedish Police Academy prior to joining KI. He is the author of three books along with several book chapters and peer-reviewed papers. He currently supervises two PhD-Candidates in educational leadership.

How can we encourage active design of CME-CPD events?