The next couple of posts will include quotes from Mister Rogers (Fred Rogers).

The world would be a better place if we all were a little more kind, just as he was.

I’ve often hesitated in beginning a project because I’ve thought, “It’ll never turn out to be even remotely like the good idea I have as I start.” I could just “feel” how good it could be. But I decided that, for the present, I would create the best way I know how and accept the ambiguities.

-Fred Rogers

There will always be ambiguities. Your best work is created by improving the “best way you know” and continuing to create things that are meaningful to you.

-This is an excerpt from the book The World According to Mister Rogers.

Critical Thinking

If I had a nickel for every time a co-worker has said “where was the critical thinking” I could buy a lot of things at the dollar store. 🙂

Joking aside, this is one of the most common (and recurring) themes of feedback I hear about our colleagues in healthcare.

Unfortunately, the type of education and teaching we provide often reenforces this lack of thinking. While there are organizations (think “bigger”) with more technology and virtual learning spaces, the vast majority of healthcare facilities cannot afford this type of resource.

The alternative is to be creative and create learning that will test critical thinking. Learning that empowers Nurses to make decisions and see what happens next, with the safety of being wrong. Learning that allows Pharmacists to see the whole picture and think quickly to solve a problem.

You all have the ability to build this type of education. Our workforce will be better for it.

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A good mix with the idea of infinite learners is how we learn. One such strategy is ultralearning.

A new book from Scott H. Young, titled Ultralearning is available now and discusses key concepts for how we can learn new ideas quicker.

Here are a few of the key principles:

  1. Design your project well – set enough time aside and limit what you are trying to learn
  2. Train Focus and Productivity – limit distractions and create a system for your learning
  3. Learn actively – in addition to some required passive learning (lectures, etc.) find opportunities to practice what you are learning
  4. Get quicker, deeper feedback – find ways to get feedback and create quicker cycles (repetitions)
  5. Space your practice out – add more practice spread out over time
  6. Practice more deeply – process what you’re learning (Feynman technique)
  7. Overlearning – continue to practice even after where you feel you’re no longer seeing any improvement

As is everything, there are various degrees of how much time you’ll spend on each of these. It also depends on what you’re trying to learn.

The best plan is to start today and monitor what works for you – then it becomes an iterative process and you can learn more efficiently…and effectively over time.

The last idea which is very interesting is meta-learning. Part of this process is to reach out to other people who have done what you are looking to do and ask them questions. You may find that there are parts you thought were important to focus on, that aren’t, or parts you hadn’t thought of that you should add to your list to research further.

The book Ultralearning is worth a read, either at your local bookstore, library, or wherever you get your books (audio, e-, or otherwise).

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Improving Continuing Education

I am inspired by a recent podcast episode of Akimbo, from Seth Godin – titled Systems Thinking. The topic can push us to think more deeply about the industries we work in and how we can improve them.

Systems thinking is basically identifying how parts are connected.

You don’t necessarily have to create the system; there are many systems in place already. The question is what can you learn about the system(s) to help you create more value for the audience you seek to serve?

A way to apply this idea is seen with Jim Collins’ Flywheel effect. Here we see a cumulative process – drip by drip, step by step, with a bias for action, and it all adds up to create effective results.

Taking the lens of continuing education for health care professionals, here are the pieces of the system:

  • Accreditation organizations (those who approve accreditors and those who accredit programs/education providers)
  • Speakers
  • Learners

Part of the idea of a system is that if one of these components is removed, the system would not exist.

Without learners, there would be no one to educate. Without speakers (or SME), there would be no one who teaches, etc.

[I’ll carve out continuing professional development and self directed learning for now but we’ll cover that in a future blog post. At least for pharmacists, we are required to take accredited courses for those “hours” to count towards annual requirements.]

Bringing back the Flywheel Effect, you can focus improvement on what you want the system to look like and build changes in one part, while knowing how it’ll affect the rest of the system. It is important to remember your changes depend on how each part fits with the other parts.

You can improve the quality of your speaker(s), but if the type of learning for attendees doesn’t match what learners are looking for, then you will see limited improvement in the system. If one thing moves, they should all move.

One area I’m most interested in developing further is changing the types of learners (and disciplines) who are attending meetings. Many conferences implicitly promote silos as they are created for one discipline and are primarily didactic lectures.

One way to combat this while looking at the system is to create more interdisciplinary conferences with interactive sessions and create ways to bring the content back to where attendees work (their own organization). Changes include adding different disciplines, different types of speakers who are engaging and maximize how to promote participation. Lastly, the education provider would need to provide accreditation for all the disciplines who attend. Potentially, one organization could do this but more than likely (and preferably), a collaboration of groups is what you would see.

It’s a new way forward, using the current system, and making small changes, course by course, to create a more effective way to improving continuing education.

Photo by Bill Oxford on Unsplash

I have three assumptions to note:

  1. Accreditation is required to provide education to health care professionals
  2. What’s it for – continuing education is to help maintain competencies and expand on knowledge to improve patient care. What’s it sometimes for – meeting mandatory requirements.
  3. I’m starting a deep dive on systems thinking and the ideas here are subject to change…in fact, they probably will.


At some point during school, I made a slow transition from learning to trying to get the right answer. If that was the only step, while not ideal, it wouldn’t be terrible.

Unfortunately, the next transition is a bumpy one – from trying to have the right answer to trying to not have the wrong answer. While subtly different, there’s a huge gap in mindset.

it was in this time period when my Residency Director shared a quote with me:

“What would you attempt to do if you knew you could not fail?”


Up to a point, this is a helpful question. To act “as if” and move forward.

Eventually, this isn’t the most important question to ask. Perhaps another subtle difference, but vitally important:

What would you attempt to do, if you didn’t know whether it might fail, and you do it anyway?

It might not work. And you do it anyway.

That’s how we learn.

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Keep Asking Questions

Every day, I hope to keep learning and keep asking questions.

Learning is the easy part – you can learn about yourself, a colleague, quite literally – anything new. That’s learning.

Asking questions – good questions, is a little more challenging. It takes curiosity, being present, and empathy. Add in a little IQ, EQ, and BQ (body intelligence), and you’re on our way.

Here is a list of my (current) favorite questions:

“What’s the ONE Thing you can do this week such that by doing it everything else would be easier or unnecessary?”

Gary Keller, from The One Thing

“What would this look like if it were easy?”

Tim Ferriss

“If you are saying yes to this, what are you saying no to?”

Michael Bungay Stanier, from The Coaching Habit

“Who’s it for? What’s it for? What is the change you seek to make?”

Seth Godin

OK, this last one, I included three – but they are each very powerful and could stand on their own.

“What do you think?”

Tom Peters, from The Excellence Dividend

“What problem are you solving?”

“Is this actually useful?”

“Will this change behavior?”

Jason Fried & David Heinemeier Hansson, from Rework

I’m sure there are many more questions we can add into our toolbox. For now, these will get you started and on your way to creating more meaningful…anything.

Keep asking questions – KAQ.

Here are links to books mentioned in this post:

The One Thing

The Coaching Habit


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The Cost of Accreditation

Accreditation is a necessary part of education programs. For an educational organization to provide learning to healthcare professionals, the course/class has to be accredited.

But wait, in reality – providing education does not require accreditation. However, getting a Nurse or Pharmacist to take the course, accreditation is a piece learners are looking for.

For an educator to provide accredited courses, they will need to meet standards created and monitored by their respective accrediting organization.

For Pharmacy, accreditation is set through the Accreditation Council of Pharmacy Education (ACPE); Nursing is through American Nurses Credentialing Center (ANCC) [or the American Association of Nurse Practitioners (AANP)]; there is also a joint accreditation option through Joint Accreditation – Interprofessional Continuing Education, which offers accreditation for CME, CNE, and CPE – and recently has added the option to include PAs, Social Workers, Optometrists, and Psychologists.

To give you an idea of the costs for accreditation, here are a couple of tables:


Nursing (annual fees):

Joint Accreditation:

Zooming in on Pharmacy, the annual fee is dependent on how many credits you offer and how many learners you have within those learning activities.

Zooming way in – ESU is calculated by taking the number of continuing education units (CEUs) of a CPE activity multiplied by the number of participants receiving an ACPE statement of credit or certificate for that activity. Adding the total ESU of all your programs puts educators in a specific level, which decides the annual fee.

When deciding to get accredited, there are many pieces to weigh/factor in. Mostly, it comes down to how many courses are you offering per year and how many learners do you anticipate attending (not including administrative and IT components needed to meet ACPE requirements). From there you can decide if the cost of accreditation is affordable or is it less expensive to get your program accredited individually through another organization – with corresponding fees.

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What’s a Needs Assessment?

Knowing what your audience needs to learn (or wants to learn) is an important first step in creating content. In the world of healthcare education, it is also a required component for any education you create. While this topic may appear dull at first, there is a simple reframe for it – you get to connect with your learners, hear what they need to learn and you build trust by continuing to listen to them and create education they are looking for.

The two most common forms of needs assessment we see are the Annual needs assessment survey and a post-course evaluation, which includes a question on what topics learners would like. These are also known as verbalized needs.

Needs can also be identified by looking at gaps in care when reviewing recent research or reading literature from different National Organizations (e.g. CDC, AHRQ, etc.).

However, there is a gap in the data you are collecting, especially with verbalized needs. People do not always know what they want. Typically, you are interrupting learners to get their feedback or adding it into an evaluation – the problem is that you are asking at one point in time. Often, they skip the section on the survey asking what topics they want to learn more about.

How can you connect with learners when they don’t tell you what they want to learn? First, you start with people who are telling you. Second, at a live conference you spend time talking with attendees about the sessions and listen to their responses – it’s a good indication of a needs assessment as you’ll get.

A good needs assessment looks at where the learner is and where they want to go. One of the roles of an educator is to help them meet their professional development goals. Not only will taking the time to ask deeper questions help you identify more engaging and meaningful content but you’ll also build a stronger connection to your audience by seeking enrollment.

Listening, asking better questions, and providing a survey that isn’t an interruption – start with these three tools and you’ll be on your way to developing more meaningful education.

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Marketing: What I’ve Learned…so far

I hope you enjoy a slight variation in today’s blog post. Here are some thoughts on a recent Workshop I participated in.

January 2019

In January 2019, I started an epic marathon and just last week, I finished it. Phew!

Not too bad for my first marathon – but it wasn’t running, it was The Marketing Seminar (TMS), an Akimbo Workshop, created by Seth Godin and happened to be my 4th Akimbo Workshop within one year.

This iteration happened to be the sixth offering of TMS and followed the release of This is Marketing, Seth’s 19th (best-selling) book.

It includes 60 deep, thought provoking lessons. And I signed up on purpose!

Part of my celebration is to write this post, as gently nudged by my (new) partners in crime, Staci Boden and Dave Bates – two wonderfully kind and generous people.

Without further ado…here are my thoughts on Marketing.

Marketing in the 21st Century focuses on making change happen. To do this, you need to know what change you seek to make.

The key questions to start with (always):

  • Who’s it for?
  • What’s it for?
  • What change are you seeking to make?

To clarify what your position is, you’ll need to have answers to these questions. Zooming in to the smallest viable audience is typically a great place to start.

Marketing is more than SEO or short advertisement focused emails. These are all too common and often many people gravitate to them – the shortfall is that they steal attention and time – two resources that are in short supply.

So if it isn’t SEO, what is Marketing consist of? It is earning trust, seeking enrollment, creating tension, showing up consistently, and bringing the generosity. Combined with learning more about these themes, TMS provided an opportunity to add clarity to my project. (This website was created and designed while in the second half of the Workshop, again nudged by friends in the Workshop.)

Adding clarity to one’s own project is one of the most profound aspects of TMS. Interestingly enough, I went in with one idea and it evolved to something better. Better in terms of the change I seek to make. We learn to make things better by making better things.

In big part, the design of the learning space (or container) is what stands out. As an educator, here are some critical components:

  • Quality of the lessons (trust in Seth Godin as a teacher/leader in Marketing)
  • Cadence of the lessons dropping (they do not all come out at once)
  • Format of promoting participation – both to find the others and to work with people outside of your specific industry
  • Posture of the Coaches and students (and Remarkables)

The questions themselves helped create new ideas but the power of the Workshop is the cohort – the peer to peer participation and connection that helps us make significant progress. It’s a community of like-minded people.

People like us, do things like this.

-Seth Godin

July 2019

It was an amazing seven months – 200 days – and I’m grateful for all the great people I was fortunate to meet and learn from. Thank you!

Stay tuned for a new education Podcast and come back for more posts here.

I’m looking forward to being part of future Akimbo Workshops. I’d love to see you there and I cannot wait to meet you.

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Adaptive Learning

When many of us took licensing exams, we experienced “adaptive testing” or CAT – computerized adaptive testing. While we answered questions, the algorithms in the test would change the questions based on our responses.

While CAT has been used for well over a decade, the use of adaptive learning (or adaptive teaching) has gained popularity in the last 5-10 years. Similar to testing, the AI/algorithms will adapt to the strengths and weaknesses of the learner, based on mastery and knowledge of the content.

(A quick side note: A recent episode of Akimbo by Seth Godin talked about Systems Thinking – and how we can learn about the systems available in our industry and how to use them effectively)

A specific framework used is ALGAE (Adaptive Learning for GAme dEsign). This concept uses a mixture of game design, adaptive learning and instructional/teaching models to enhance learning.

If you’re interested in adaptive learning, here are some additional resources:

Happy Learning!

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