Bowling Green State University

ScholarWorks@BGSU
Master of Education in Learning Design Plan II College of Technology, Architecture and Applied
Graduate Projects Engineering

Fall 12-8-2014

A Blended Learning NPR Training Module for IT

Staff
Tracie Henson
Bowling Green State University - Main Campus, [email protected]

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A BLENDED LEARNING NPR TRAINING MODULE FOR IT STAFF

Tracie Henson

A Major Project

Submitted to the Graduate College of Bowling Green

State University in partial fulfillment of
the requirements for the degree of

MASTER OF EDUCATION

December 2014

Committee:

Kathryn S. Hoff, Ph.D., Advisor

Gary Benjamin, Ph.D.

© 2014

Tracie Henson

All Rights Reserved

iii

ABSTRACT

Dr. Kathryn S. Hoff, Advisor

The problem of the study was that there was a need to provide additional training to

employees of the Information Systems (IT) Department of a regional hospital in the utilization of

the Non-Procedural Report (NPR) writing function of the hospital’s Healthcare Information

Systems (HIS). The current methods of NPR training lacked structure and depth and did not

fulfill the needs of the IT staff to be able to focus on the proper actions needed to produce

reports. The design and development of the blended learning module Creating Your First NPR

Report was created to fill that need and provided an effective way for IT staff to adopt efficient

strategies for learning NPR report writing skills and thus providing a valuable service to the

hospital departments. The study had systems analysts as participants from the IT department.

The preliminary assessments establishing departmental reporting requests, software

research, and learning needs for IT staff was achieved through a series of departmental question

and answer sessions, software research, and an IT Staff – Knowledge Survey. The obvious lack

of understanding of the basic principles of NPR report writing prompted the purpose and

objectives for designing a blended learning module.

During the implementation of the blended learning module, a face-to-face, instructor-led

session was conducted with the use of a PowerPoint presentation and hands-on demonstrations,

which helped reinforce the correct way of designing NPR reports. The just-in-time information

was provided along with reinforcing video presentations that helped the participants gain

valuable knowledge about NPR report writing.

iv

A post survey was conducted as an evaluation tool for the instructional methods used in

each of the blended learning techniques. Performance and production of the NPR report from

the face-to-face instructor-led sessions also served as another method of evaluation. The results

from the survey reinforced the need for the blended learning training. An outcome of the study

was the implementation of the blended learning training module given to other participants of the

IT department and future modules that will help IT Staff create more robust reports for hospital

departments.
v

I dedicate this project to the IT staff who assisted and participated in the study and to my director

who allowed me to complete this while still doing my other duties.

I also want to dedicate this project to my family and especially my husband, for without his love

and support I would not have been able to accomplish great things. His unselfishness during the

course of my graduate studies truly deems him to be a “saint among saints”. I especially thank

him for having dinner made when I get home from work and bringing me endless coffee in the

“Bat Cave” while I was doing schoolwork. His love is infinite, I appreciate him every day and

his favorite phase “I can’t wait to get my wife back” is now a reality.

Lastly, I want to thank God, for without him in my life I would not be able to do anything.

Everything I have and accomplish comes from him!

“May he grant your heart’s desires and make all your plans succeed.”

Psalm 20:4 (NLT)

vi

ACKNOWLEDGMENTS

I would like to thank Dr. Gary Benjamin for being a part of my journey the last five years

at Bowling Green State University. You have been a great professor, mentor, committee

member, and friend. Thank you for your time and insight on my achievements.

I especially would like to thank Dr. Kathryn (Kate) Hoff for not only being a great

committee chair, advisor, mentor, and professor, but for being my friend and confidant as well.

Your constant involvement with my studies has helped me grow in not only knowledge of the

subject, but in knowing life as well. Your friendship is something that I will always cherish.
vii

TABLE OF CONTENTS

Page

SECTION I. BACKGROUND AND GOALS ...................................................................... 1

Problem of the Study ................................................................................................. 2

Objectives of the Study .............................................................................................. 2

Significance of the Study ........................................................................................... 3

Assumptions ............................................................................................................ 4

Limitations ............................................................................................................ 4

Identification and Description of Resources .............................................................. 4

Definition of Terms.................................................................................................... 5

Literature Review....................................................................................................... 6

SECTION II. PROCEDURES ............................................................................................... 14

Problem of the study .................................................................................................. 14

Project Plan ............................................................................................................ 14

Calendar of Events ..................................................................................................... 18

Proposed Budget ........................................................................................................ 18

SECTION III. METHODOLOGY......................................................................................... 20

Institutional ............................................................................................................ 20

Pedagogical ............................................................................................................ 20

Technology ............................................................................................................ 24

Interface Design ......................................................................................................... 25

Evaluation ............................................................................................................ 28

Management ............................................................................................................ 32
viii

TABLE OF CONTENTS – Continued

Page

Resource Support ....................................................................................................... 32

Ethical ............................................................................................................ 33

SECTION IV. RESULTS OF THE STUDY ......................................................................... 34

Summary ........................................................................................................... 34

Results and Conclusions ............................................................................................ 35

Recommendations ...................................................................................................... 38

REFERENCES ............................................................................................................ 40

APPENDICES

A: Example NPR Report............................................................................................ 41

B: Pre-survey Email ................................................................................................... 42

C: Staff IT – NPR Knowledge Survey....................................................................... 43

D: Staff IT – NPR Knowledge Survey Results .......................................................... 45

E: PowerPoint: Introduction ...................................................................................... 49

F: PowerPoint: Module 1-Data Storage ..................................................................... 50

G: PowerPoint: Module 2-Creating and Editing NPR Reports ................................. 54

H: Online Video Self-Learning .................................................................................. 59

I: Just in Time Handouts ............................................................................................ 60

J: Self Help Article Example .................................................................................... 62

K: Post Survey ........................................................................................................... 64

L: Email Communications ......................................................................................... 67

M: Post Survey Results .............................................................................................. 70

ix

LIST OF FIGURES/TABLES

Figure/Table Page

1 Badrul H. Khan E-Learning Framework……. .......................................................... 7

2 Kahn’s Octagonal Framework ................................................................................... 8

3 Gantt Chart ............................................................................................................ 18

4 Training Outline……. ................................................................................................ 27

1

Section I. Background and Goals

There was a need to provide additional training to employees of the Information Systems

(IT) Department of a regional hospital in the utilization of the Non-Procedural Report (NPR)

writing function of the hospital’s Healthcare Information Systems (HIS). Hospital departments

rely on IT staff to be able to write reports that extract important, vital information relating to

their departments. The reports are used by management, front line supervisors, financial

auditors, and accrediting agencies. An illustration of a completed NPR report of physicians is

included in Appendix A. Example NPR Report. Departments expect to have resourceful and

knowledgeable IT staff available to help design and create the reports that are needed for each

situation. The amount of time it takes to learn good NPR report writing skills has become an

issue with upper management. The learning curve was steep and IT management would like to

get new IT staff up and running with minimal intrusion to their other current daily workload.

This generates the task of creating efficient learning modules that will help IT staff become

productive and achieve consistently high performance for this task.

Current methods of NPR training lack structure and depth and do not fulfill the needs of

the IT staff to be able to focus on the proper actions needed to produce reports. Absence of face-

to-face instructions and other forms of education only increases the problem. Resource

constraints coupled with daily job challenges have placed additional pressure on IT staff creating

a demand for new approaches to training. Organizations have found that a current trend to help

increase effectiveness in staff has been to use a blended learning environment, “…a term

describing an instructional strategy that combines the use of web-technologies with more

traditional approaches, often classroom-based” (Adams, 2013, p. 2) .

2

A blended learning approach can be used to enhance learning beyond traditional

classrooms by allowing organizations to design learning capabilities that support just-in-time, or

immediate access to specific learning tools anywhere, anytime. To improve on-the-job

performance in organizations, the ability to learn at the point of need was increasingly important.

Problem of the Study

The problem of the study was that there was not a structured way of learning NPR report

writing for IT staff. The current choices for learning are not efficient or cost-effective for the

hospital. Currently, IT staff tries to produce an NPR report by trial and error, they attempt to

find precious slices of time to analyze and read through online documentation and almost all of

them end up having to ask a mentor about the process. Because of these inefficiencies, the plan

was to analyze the current NPR learning processes available and develop a supplemental blended

learning module as part of a continuing training plan for NPR report writing for the purpose of

meeting IT staff needs, becoming familiar with essential measures of the report writing

procedure, and effective utilization of the system. The plan was structured as supplemental

training with capabilities for additional outreach to the IT staff for the purpose of hospital-wide

benefits where they will gain valuable report writing skills that will allow them to produce

effective reports for hospital departments.

Objectives of the Study

The objectives of this study were:

1. To develop a specific training module titled Creating Your First NPR Report using

blended learning methodology with goals and objectives.

2. To evaluate the training module Creating Your First NPR Report first from a pre-

evaluation method from IT participants and after revisions, evaluate selected audience
3

of IT systems analysts based upon actual performance and production of an NPR

physician report that relates directly to a specific hospital department – Medical

Records - who had requested a need for it to be created. A separate evaluation of the

overall module will be achieved through the utilization of a survey among the

participants.

3. To implement the blended learning training module as a template for future blended

learning training modules.

Significance of the Study

In prior organizational meetings, management confirmed that our HIS system of choice

would be a software product created especially for inpatient, outpatient, surgical and ambulatory

hospitals. The product, Meditech, has a proprietary report writer function. The vendor, from

Boston, Massachusetts, has offered to conduct training sessions at their on-site facility. Because

of the distance, resource and time constraints, the department deemed that it was too expensive

to do that type of training. If training could be provided on-site and during periods of the day

when IT staff could attend between regular job duties, the cost savings, quality of work and

return-on-investment could be increased. When the vendor was approached with this concept,

they could not accommodate this type of schedule. Currently, the vendor provides PowerPoint

presentations in a face-to-face hands-on environment. Because of the ineffectiveness and time-

consuming nature of this type of training, management asked if there were other choices. They

were presented with the fact that NPR training could be accomplished and delivered in-house by

current experienced NPR report writing IT staff as subject matter experts. A blended learning

approach to training IT staff would contribute to the success of the whole organization.
4

Ultimately the quality of reports that IT staff will be furnishing to other departments will be of

significant organizational value.

Assumptions

The following assumptions were made for this study:

1. The blended learning methodology used was fashioned from current standards and

techniques that have been researched and assessed in prior studies.

2. Information taken from the HIS system was complete and contains true and effective

methods to produce favorable reports for other departments.

3. The blended learning training module was evaluated by IT staff who have little to no

experience in writing NPR reports in the HIS. No prior knowledge was assumed.

Limitations

The following limitations were made for this study:

1. The computer software used to complete the online portion of the module was not

SCORM compliant.

2. The courseware was pre-evaluated by IT personnel who do not work for the hospital

and who have never heard of the HIS system. They were strictly evaluating the

effectiveness of the module for flow, user-friendliness, and completeness.

Identification and Description of Resources

This study was encouraged and supported by the IT administration of the regional

hospital. Resources utilized in the creation of the blended learning training module Creating

Your First NPR Report included:

• Screen recording software such as Camtasia Studio 7 and SnagIt.

5

• Module creation using Adobe Captiva.

• Hospital Intranet for hosting video production and learner education.

• Network resources for video viewing and readily available documentation and help

content.

• Human resources such as subject matter experts in the field of NPR report writing,

usability testers, and current employees of the IT Department.

Definition of Terms

For the purpose of this study, the following terms were operationally defined.

Non-Procedural Report (NPR) is Medical Information Technology, Inc. proprietary report

writing feature of the software. The report writer allows the users to create custom

reports.

Medical Information Technology, Inc. commonly called MEDITECH is a Massachusetts-based

software and service company that sells information systems unique to health care

organizations (Meditech, 2014).

Blended Learning is defined as the combination of different types of instructional deliveries.

This could include the use of digital media, web-based technologies and synchronous

classroom style lectures. This is all designed to balance each other and promote learning

and application-learned behavior (Singh, 2003, p. 52).

m-Learning is defined as mobile learning on a mobile device, such as a smart phone. When used

in context of work place learning, the employee would be able to access on the job

training via a mobile device. Another example would be just-in-time training to solve a

particular problem or to gain insight on how to accomplish a task. M-Learning could be

things as simple as a reference guide, checklists or an eBook.

6

Literature Review

A blended learning module was created for the IT staff of a regional hospital to help

demonstrate and utilize the Non-Procedural Report (NPR) writing function of the hospital’s

Healthcare Information System (HIS). Blending learning methodology will incorporate face-to-

face education that will help IT staff focus on the proper procedures needed to construct a report,

online lessons that will reinforce classroom instructions and additionally, blended online how-to

videos that IT staff will be able to view to strengthen their knowledge learned from the blend.

This type of m-learning will bring them to the just-in-time training or refresher they may need to

keep their cognitive knowledge at the forefront.

Because of the type of learning environment chosen, research on the best possible way to

produce a blended learning environment was in order. The more recent research has proven

documented methodology that allows for optimal learning through different types of

communication channels.

Blended Learning in History

As the name implies, blended learning represents the mixture of different types of

educational teaching methods. It is an integrated approach for both instructor and learner. The

mixed-mode instruction of a classroom setting, or face-to-face meeting combined with computer-

mediated activities create an optimal knowledge experience for the learners. But before phrases

such as blending learning or e-learning were introduced into educational pedagogy, the concept

of web-based instruction was introduced to the world. In 1997, Badrul H. Khan, Ph.D., wrote a

best-selling book entitled Web-Based Instruction that paved the way for the new field of e-

learning. Through his teachings and book publishing Khan created a basic standard for web

designed training and instruction. Web-based instruction was adopted in more than 350 colleges
7

and universities throughout the world and through his second book, titled Web-Based Training

the aspect of using the World Wide Web for training was explored. Kahn (2014) continued to

progress the field of distance learning and his eight-sided structural framework for e-learning

evolved. The sides represented specific e-learning issues and are systemically interconnected to

support learning. Using Kahn’s E-Learning Framework (see Figure 1) assures that learning

outcomes are achieved. The approach took each of the eight sides and interconnected them to

help identify the critical issues that needed to be addressed when creating context and audience.

Figure 1- Badrul Khan E-Learning Framework (Khan, 2014)

Singh (2003), author of the article Building Effective Blended Learning Programs

brought Khan’s E-Learning Framework to the blended learning dimension and discussed two

objectives. The first objective was to show an in-depth view of blended learning and to discuss

the ingredients or methods to use in the blended learning program. The second objective was “to

provide a model to create the appropriate blend by ensuring that each ingredient, individually

and collectively, adds to a meaningful learning experience” (Singh, 2003, p. 51). He relates to

the blended e-learning framework of Badrul Khan. The Octagonal Framework (see Figure 2)
8

shows how to select the appropriate ingredients and should serve “as a guide to plan, develop,

deliver, manage and evaluate blended learning programs” (Singh, 2003, p. 51).

Figure 2 - Khan's Octagonal Framework (Singh, 2003)

The author introduced Khan’s Octagonal Framework and gave each dimension of the

framework a category of issues that needed to be address. He narrated that once the issues are

addressed within the framework, it will help organize thinking and make sure that the blended

learning program is a meaningful learning experience. Appropriately enough, his concept would

give organizations the plans for effective learning and performance evaluation and ensure

effective transfer of learning for their return on investment.

According to design expert, Singh (2003), blended learning modules must consist of

strategies for effective learning and performance and consider different issues to create effective

delivery of learning that result in high return on investment for the organization. To promote

learning and application-based behavior, the modules will combine different types of delivery
9

media that will complement each other. The eight elements include institutional, pedagogical,

technological, interface design, evaluation, management, resource support, and ethical.

Institutional

This dimension addresses issues of the organization and/or administration. The

organization and its administration should be prepared to stand behind the development of the

blended learning module. The availability of subject matter experts should be in place along

with the infrastructure.

Pedagogical

This dimension addresses several issues including content analysis – the way the learning

content will be delivered, audience analysis of the learners needs, and goal analysis including

learning objectives. This would cover the design and strategy phase of the e-learning portion of

blended learning.

Technological

The delivery methods that are identified and will be part of the blend need to include

technology issues and how they will be addressed. This should include the creation of a learning

environment and the tools to deliver the learning process. Issues will need to be refined such as

the use of a Learning Management System (LMS) that can manage different types of content;

online and face-to-face learning.

Interface Design

The interface design dimension identifies how the user interface should be created.

Issues addressed in this dimension are things such as the correct number and type of elements

needed on the user interface and making sure that it works into the blended program. There
10

should be enough complexity to house different elements of the blend and be able to switch

between the two different types of sources.

Evaluation

Designing the interface is a crucial element when developing the blended program but the

evaluation of the module as a learning tool will also be an important part of the process.

Evaluation of the effectiveness of the blended learning project along with the performance of the

learners within the program will need to be developed.

Management

This dimension addresses issues that relate to the management of the blended program,

such as organizational structure and work-flow to manage multiple delivery types. This would

address the need for issues such as learner registration and notification, and scheduling of the

different elements of the blend.

Resource Support

Resources include items such as offline or online content and making it available to the

learners. Organization of each type of content will need to be planned and readily available to

the learners. Resource support could constitute having a tutor or mentor available in person, via

email or on an online chat system.

Ethical

Ethical issues that need to be addressed when developing a blended learning program

would include such things as equal opportunity, diversity, and nationality.

Blended Learning Presently

Creating a blended learning environment that promotes learning with results that can be

measured are challenges found today. Challenges include things such as technical,
11

organizational, and instructional tasks. Hofmann (2011), a synchronous learning expert, reported

the top 10 challenges a trainer in blended learning will need to look out for including tasks such

as resisting the urge to use technology just because it is available and to make sure that the

organization is onboard so they realize the extensive process needed for a blended learning role

in their organization. The instructional designer would need to look at challenges such as

matching the best delivery medium to the performance objective and making sure that all of the

elements of the blend are coordinated. She suggested making a “visual course map” (Hofmann,

2011, p. 13) and a solid communication plan.

This approach was echoed by Collins (2011), vice president of product development for

ESI International, writing about experiencing the pitfalls that can occur with even the best-laid

design. She gave us a “behind-the-scenes look at blended learning and highlight potential risks

and trouble areas that will enable you to minimize headaches and maximize learning outcomes

and investment” (Collins, 2011, p. 58). She formulated some basic tips to help stay clear of

trouble spots. Design for success was one of the things she mentioned as it is all about the

learner. Identify and document goals and requirements early on in the process. Start small and

use a scalable approach. Make sure that the executive sponsor is on board and make sure that

you partner with your IT staff. The biggest challenges facing organizations is “establishing

requirements and identifying what issues they need to address” (Collins, 2011, p. 58). However,

once the requirements are identified, business goals and problems should be used to create

learning outcomes. She suggested that by starting small, perhaps with a pilot program, the

company could highlight the results to the shareholders and get them committed with the blended

learning approach. One important idea was that the learners need to be enthusiastic about the

blended learning lessons. They need to see the value of the education or their commitment will
12

not be there. Another noted idea was the need to “communicate to the managers and the learners

upfront that blended learning isn’t an event, but a process” (Collins, 2011, p. 61).

Another columnist, Hovis (2012) explained that a blended learning approach “with

chunked learning content and assets can be a convenient and effective solution” (Hovis, 2012, p.

76). Her approach on creating blended learning for others who have a busy schedule is

something that will need to be kept in mind during the development of this blended learning

module. Self-paced e-learning would be one way for busy IT staff to adjust their schedules or

help them gain access to the just-in-time information that is needed. Hovis highlighted a

checklist that addressed steps that could be followed to create an effective program. Modeling

after her checklist and concepts, the following list would address the success of an effective

blended learning module for IT staff:

• Make sure that everyone involved knows the goals, program requirements and

prerequisites.

• Consider the types of learning and delivery methods that make sense and that would

satisfy the goals and objectives of the module.

• Translate business goals into objectives.

• Keep in mind the differences in the delivery methods and how participants will react

to them.

Summary

Blended learning and the environment in which it is developed is a delicate blend of

learning approaches. “It is a matter of getting the right content in the right format to the right

people at the right time” (Singh, 2003, p. 51). Insight to the best possible approach for a blended

learning environment and the methodology to use ultimately will be determined by the audience,
13

learning objectives, goals and time constraints. The research that has been done on the subject of

blended learning will help in the creation of a model for IT staff. Taking into consideration all of

the different aspects of the blend, Singh’s description of Khan’s Octagonal Framework model

will be used as a reference to make sure that all of the strategies are covered. Effective

development will produce a blended environment that will produce desired organizational

results.
14

Section II. Procedures

The blended learning module Creating Your First NPR Report will be the start of a

development of subsequent training modules related to NPR report writing for IT staff. Included

in this section is the statement of the problem, project plan including research, audience analysis,

scope, goals and objectives, methods of evaluating, and calendar of events along with a proposed

budget.

Problem of the Study

The problem of the study was that there was not a structured way of learning NPR report

writing for IT staff. The current choices for learning are not efficient or cost-effective for the

hospital. Currently, IT staff tries to produce an NPR report by trial and error, they attempt to

find precious slices of time to analyze and read through online documentation and almost all of

them end up having to ask a mentor about the process. Because of these inefficiencies, the plan

was to analyze the current NPR learning processes available and develop a supplemental blended

learning training module as part of a continuing training plan for NPR report writing for the

purpose of meeting IT staff needs, becoming familiar with essential measures of the report

writing procedure, and effective utilization of the system. The plan was structured as

supplemental training with capabilities for additional outreach to the IT staff for the purpose of

hospital-wide benefits where they will gain valuable report writing skills that will allow them to

produce effective reports for hospital departments.

Project Plan

To complete this study the following plan and procedures were followed:

1. Content Research
15

a. Research on learning and training needs

b. Research the Meditech software for NPR report writing

c. Establish the departmental reporting needs and reason for having NPR reports for

the learning module

d. Research the best blend of learning for adult learners

2. Audience Analysis

a. Determine who should benefit from this study

b. Geared towards newer IT staff

c. Capable of collecting information for dissemination to other IT staff

d. Adaptable to varying levels of learning

3. Scope

a. Face-to-Face – Instructor-led

b. Online Content – Self Instructional video content and reinforcement exercises

c. Just-in-Time Content – Including self-help content

4. Develop training module - General Learning Goals and Objectives

a. At the end of the blended learning module, IT staff

i. Will be able to recognize and articulate the foundational assumptions and

Data Procedure Module (DPM) File structures of Meditech’s report

writing functions

ii. Will have increased knowledge of NPR report writing

iii. Will be able to utilize Meditech’s report writing online documentation

iv. Will be able to write an NPR report using Meditech’s NPR report writing

tool to meet a specific departmental need

16

5. Method for Evaluating Achieved Goals and Objectives

a. Formally

i. Face-to-Face – Instructor-led classes

1. Observation

2. Performance and production of an NPR Report

ii. Online

1. Reinforcement Exercises

iii. Survey to evaluate two basic aspects

1. Assess knowledge and attitudes toward content and training

module

2. Reaction to quality of blended learning

b. Informally

i. Questions and answers

ii. Group Discussions and online participation

1. During Face-to-Face Instructor-Led classes

iii. Individual Inquires via Coaching and Mentoring

6. Steps for Preparing Pre-evaluation of the Blended Learning Module

a. Participants solicited to provide constructive feedback on Module

i. Selection of two IT subjects who do not work in the IT systems analyst

department at the regional hospital but are considered trainers in their

respective areas

1. Will have access to instructor notes of the Face-to-Face –

Instructor-Led classes
17

2. Will have access to printed copies of the online content

3. Will have access to printed copies of the Just-in-Time content

ii. Feedback received based on the following criteria

1. What worked or didn’t work

2. Usefulness

3. Flow

iii. Rework of Module based upon constructive feedback

18

Calendar of Events

The following was the time-line of events in order to complete the project, pre-testing,

testing and finalizing the report. It was completed by November/December, 2014. The

following Gantt chart shows the timeline of events.

Figure 3 - Gantt Chart

Proposed Budget

The following budget had been planned for the duration of 12 months.

PROPOSED BUDGET Hours Total

Researcher
Proposal Creation/Defend
Researcher Time 40 $ 1,160.00
Create Project
Researcher Time 200 $ 5,800.00
Informed Consent Creation
Researcher Time 8 $ 232.00
Recruiting of Participants
Researcher Time 8 $ 232.00
Pre-evaluate Project to Pre-evaluation
participants
Researcher Time 20 $ 580.00
19

Data Collection from Pre-evaluation

participants
Researcher Time 8 $ 232.00
Finalize Project
Researcher Time 20 $ 580.00
Deliver Final Project to Sampling
Participants
Researcher Time 20 $ 580.00
Data Collection from Sampling Participants
Researcher Time 8 $ 232.00
Write Final Report & Submit to Committee
Researcher Time 200 $ 5,800.00
Defending Final Project
Researcher Time 8 $ 232.00

Gift in Kind
IS Department
Duplication Costs
Consent Forms $ 25.00
Instructor-Led Handouts $ 25.00
Finalized Project
Sampling Participants Time 20 $ 580.00

Non-IS Department
Pre-evaluate Project
Pre-test Participants Time 20 $ 580.00

TOTALS: 580 $ 16,870.00

Number of Months to Complete

** 12 hours per week ** 12
20

Section III. Methodology

This section will serve as an overview of the steps and methods used in the creation of

the blended learning module Creating Your First NPR Report. From planning through

production and on to the evaluation of the final product, the project plan outline, literature review

and especially that of Singh’s (2003) article were necessary to achieve the creation of the

blended learning module. These steps will be detailed in this section in order to aid the reader in

understanding the process of development and the outcomes.

Institutional

Management Support

Hospital departments rely on IT staff to be able to write reports that extract important,

vital information relating to their departments. The reports are used by management, front line

supervisors, financial auditors, and accrediting agencies. Departments expect to have resourceful

and knowledgeable IT staff available to help design and create the reports that are needed for

each situation. The amount of time it takes to learn good NPR report writing skills has become

an issue with upper management. The learning curve was steep and IT management would like

to get new IT staff up and running with minimal intrusion to their other current daily workload.

This generates the task of creating efficient learning modules that will help IT staff become

productive and achieve consistently high performance for this task.

Pedagogical

Content Analysis

Content Analysis included researching learning and training needs of the IT department,

Meditech’s NPR report writing references, established reporting needs of the hospital and

finding the best blend of learning for adult learners.

21

A list of learning and training needs of the IT department were gathered through a series

of discussions with IT management and staff. The discussions unveiled the fact, among other

issues outside the scope of this project, that there is a definite lack of knowledge in Meditech’s

NPR report writing that would justify the creation of a supplemental blended learning module.

Research also concluded that Meditech’s web references to the report writing feature had

a minimum amount of information. There were however, some video references that were

necessary to help reinforce the learning.

Reporting needs of the hospital departments were researched by gathering a list of reports

desired, their purpose and who they would benefit. From that list, the Medical Records request

for a physician’s report was chosen as the outcome of this project.

Research on finding the best blend of learning for adult learners came from the literature

review. References to starting small and using a scalable approach were proposed by Collins

(2011). The busy schedules of IT staff would make it necessary to provide them with chunks of

information explained by Hovis (2012) so that learning could be intertwined with their other

daily activities. Getting the learner excited about learning and stressing that learning is not an

event but a process was another suggestion by Collins (2011). A simple preliminary checklist

was created that would address the success of the blended learning module. The checklist

included 1) making sure that learners know the goals and requirements, 2) consider the types of

learning and delivery methods that would satisfy the goals and objectives 3) translate business

goals into objectives and 4) keep in mind the differences in the delivery methods and how

participants will react to them.

22

Audience Analysis

Audience Analysis of learner needs included research into who would benefit from this

study. A pre-survey was created and emailed to IT staff. See Appendix B: Pre-survey Email.

The survey included questions that would show the knowledge level of the learners on several

concepts of report writing along with demographics and how they learn best. A sample pre-

survey can be found in Appendix C: Staff IT – NPR Knowledge Survey.

When the results of the pre-survey were tallied, 25 of 30 IT staff responded for an 83%

engagement rate. The survey questions and IT staff answers about Meditech’s acronyms were in

line with what the researcher expected. For the two questions, how many NPR reports have you

created from scratch and how many NPR reports have you modified, 76% or 19 of the

respondents reported zero to each of these questions. That is a significant percentage

considering that only 12% or 3 respondents had responded that they have written 10 or more

reports from scratch and have modified 10 or more NPR reports. Clearly there is a need for NPR

training among the respondents. The next set of questions was demographic in nature, which

asked the respondents how long they had worked for the hospital’s IT department. The average

length of tenure of the respondents was between 1-3 years. An additional demographic question

inquired as to what IT department the respondents worked in. 36% of the respondents were

Systems Analyst, 28% were Clinical Systems Analyst, and 24% were Service Desk Analyst. It

should be noted that a requirement of the IT Systems Analyst job states that they will be able to

produce reports from the data stored in the hospital’s information system. The survey question

on how best do you learn, 83% of the respondents noted that they learn better by kinesthetic and

17% as visual learners. Of the 25 respondents, 79% or 19 of them responded that they would
23

like to learn how to write NPR Reports. See Appendix D: Staff IT – NPR Knowledge Survey

Results.

Based on the results of the pre-survey and the requirement of their job description, three

IT systems analysts were chosen as a cohort to participate in this study. It was noted that once

the project was completed that roll-out of the blended learning module to the rest of respondents

will be done.

Goal Analysis

Learning objectives were determined as a result of goal analysis. The organizational goal

was to make sure that IT staff can learn NPR report writing to be able to produce reports for

other departments. The following learning goals and objectives were developed for the blended

learning module.

At the end of the blended learning module, IT staff

• Will be able to recognize and articulate the foundational assumptions and Data

Procedure Module (DPM) File structures of Meditech’s report writing functions

• Will have increased knowledge of NPR report writing

• Will be able to utilize Meditech’s report writing online documentation

• Will be able to write an NPR report using Meditech’s NPR report writing tool to meet

a specific departmental need

Scope

Taking into account each goal and objective, the scope of the blended learning project

was developed. The scope would include a Face-to-Face instructor-led class, online content

including a self-instructional video with additional information to help reinforce the concepts

delivered in the face-to-face class. The just-in-time content included items such as handouts
24

during the face-to-face class and research articles in a location that the learners would be able to

reference anytime, anywhere while on the hospital’s network.

Technology

Content Delivery

Content delivery for the different types of blend in the scope needed to be considered.

The technology needs to accomplish the blended learning module Creating Your First NPR

Report should have a minimal impact on hardware and software resources along with minimal

impact on network resources. With that in mind the following technological study for content

delivery was conducted.

Face-to-face instructor-led class technology would include the following:

• Software resources including Microsoft Office Suite to produce the PowerPoint

presentation and just-in-time handouts. Also, access to the Meditech’s software via

the terminal server platform would be needed

• Hardware resources including thin client technology that will allow access to the

hospital’s HIT system via the term server farm

• Network resources including shared file folder location for the PowerPoint

presentation and handouts

• Training room resources including projector and laptop, thin clients for the cohort to

use during the instructor-led class and to produce an NPR report

Online Content – self instructional video content and reinforcement exercises:

• Video-making software resources including Camtasia Studio 7 and screen capture

software SnagIt
25

• Hardware resources including Windows PC running a version of Windows Media

Player to observe the video

• Network resources including a shared file folder where online content can be located

Just-in-Time Content including self-help research articles:

• Software resources including Microsoft Office Suite to open the documents

• No Hardware resources were noted

• Network resources including a shared file folder where just-in-time content and

research articles can be located

Interface Design

The analysis performed on content, audience and goals helped build the scope of the

project. Available technology for each element of the blend was examined and taken into

account during the design phase. Appropriately, the following elements for each blend were

developed.

Face-to-Face Instructor-led class

Based on the approach of Hovis (2012), it was noted to keep the face-to-face blend short

and simple but meaningful to meet the objectives and goals. The cohort had limited amounts of

time in their busy days to be able to sit in a classroom for lecture. With that in mind the

following training outline (see Figure 4) was created with corresponding PowerPoint slides and

instructor notes. The face-to-face instructor-led class would have three parts; introduction to

Meditech’s NPR report writing (See Appendix E: PowerPoint: Introduction), data storage (See

Appendix F: PowerPoint: Module 1-Data Storage), and creating and editing NPR reports (See

Appendix G: PowerPoint: Module 2-Creating & Editing NPR Reports). Each module, other than

the introduction, had its own set of objectives that aligned with the learning goals. There were
26

reinforcement exercises throughout along with hands-on demonstrations that satisfied the

learning needs of those who learn best by kinesthetic and visual.

Training Outline
Introduction
• What is NPR
• What is the NPR Report Writer
• Pages in NPR Report Writing Screens
o Page One – General
o Page Two – Sorts/Selects
o Page Three – Picture

Module 1
Data Storage
• Objectives
o Examine how data is stored in a hierarchical structure within an NPR application
o Understand how to read the Data Definition List
o Learn how to access data fields on an NPR Report
• Common Terms
o Field – smallest piece of significant data
o Record – Grouping of related Fields
o File – Grouping of related Records
o Hierarchy
Application – the highest level – a collection of programs
DPM (Data Procedure Module – a set of closely related data files
Segment – a file where fields are stored
• Collection of segments within a DPM - based on the relationship
between the data in each segment
o Parent (Main) Segments
o Child Segments
Relating Enter/Edit Screens to the Hierarchy
• Illustration from the Physician Dictionary
o Data Definitions
o Storing and Retrieving Data
o Subscripts
Urn
Mnemonic
Others
• Integer
• Date
• Reinforcement Exercise One
• Reinforcement Exercise Two
• Reading a Data Definition
27

o Subscripts
o Physical Base
o Field Name
o Len-Length
o Data Type
o Justify
o DPM
o Offset/Local/VAL
• Reinforcement Exercise Three

Module 2
Creating and Editing NPR Reports
• Objectives
o Introduce Keystrokes specific to the NPR Report Writer
o Create a simple custom NPR report to list data in a column format
o Demonstrate the effect of a detail segment on a report
• Process Reports
o Report Objective
DPM?
Name?
o Identify a New Report
o Identifying Existing Reports
o Other Report Subroutines
Report Subroutines
• Enter/Edit – allows you to edit the report
Macro Subroutines
Screen Subroutines
Procedure Subroutines
• General Page
o Report Title Section
o Detail Segment and Index File Section
o Page Characteristics
o Report Regions Section
o Exercise 1 – General Page Summary
• Picture Page
o Components of Report Picture
Report Fields
Attributes and Field Markers
Report Regions
Report Picture
o Exercise 1 – Picture Page Summary
Demonstrate the effect of the detail segment on a report
• Warning message when changing the detail segment on the report
Figure 4 – Training Outline
28

Online Content

The online content was the development of a self-learning video derived from Meditech’s

video archive. The video called Finding Data Seminar was reproduced using Camtasia Studio 7

and published as an .mp4 video. Producing as a smaller-sized video file assured that it would

play smoothly on the available network. The self-paced video reinforced the concepts learned in

the face-to-face instructor-led class and is directly correlated to the learning goals. See

Appendix H: Online Video Self-Learning.

Just-in-Time Content

The just-in-time content was two-fold. During the face-to-face instructor-led class,

handouts of Quick Reference Guides were provided. See Appendix I: Just-in-time Handouts.

Additionally, a printed copy of the PowerPoints was distributed to the participants for

reinforcement of learning beyond the classroom as a suggestion from the pre-evaluation result.

Another type of just-in-time content was the selected research articles that were gathered for the

cohort to access anytime they needed. The research articles not only reinforced the face-to-face

instructor-led class, but also provided additional information that could be useful for the learners.

Examples are provided in Appendix J: Self-Help Article Example.

Evaluation

Pre-evaluation

Pre-evaluation of the blended learning training module was accomplished by the

following methods. Selection of two IT subjects who do not work in the systems analyst

department but are considered trainers in their respective areas. They were provided the

following items:

• Instructor notes/outline of the face-to-face instructor-led class

29

• PowerPoint presentations of the Introduction, Module 1 and Module 2

• Access to the file location of the online content video

• Access to the file location of the just-in-time content and self-help research

The selected pre-evaluation participants were given one week to finalize their findings

and a meeting was called to discuss. They were to look at the following three criteria while

evaluating the course:

• What worked or didn’t work

• Usefulness of each of the blends

• Flow

The result of their pre-evaluation overview was positive on all three criteria with one

minor change to the flow of the blend. They suggested that the just-in-time handouts during the

face-to-face instructor-led class also include a printout of the PowerPoint slides. This, they

stated, would help reinforce what was being said and notes could be taken on the different areas

of instruction during the class. Their suggestion was incorporated into the blended learning

course when it was delivered.

Informally

Informal methods of evaluation included question and answer sessions, instructor

perception of participants body language, and group discussions during the face-to-face

instructor-led class. Mentoring or coaching was exercised during other times.

Formally

Formal methods of evaluating the blended learning consisted of the following. For the

face-to-face instructor-led classes, evaluation was having each participant produce the NPR
30

report in Module 2. In order to evaluate the online content of the self-instructional video, the

participants were asked if there were additional comments or questions about the content.

The last formal method of evaluation was with a post survey (See Appendix K: Post

Survey) which was given to the participants after the blended learning course was completed. A

five-point Likert scale was used in the post-survey instrument. In the first section, the

participants were asked to evaluate the following statements as it pertains to the Face-to-Face

Instructor-Led portion of the Blended Learning Module. There were a total of nine statements

they were to evaluate, rating them in response to the Likert scale on what they thought. The

statements included were:

• The objectives of the modules were clearly defined

• Participation and interaction were encouraged

• The topics covered were relevant to me

• The content was organized and easy to follow

• The materials distributed were helpful

• This training experience will be useful in my work

• The trainer was knowledgeable about the training topic

• The trainer was well prepared

• The time allotted for the training was sufficient

The second section asked the participants to evaluate the following statements as each

pertains to the Online Self Instructional Video content of the Blended Learning Module. There

were a total of four statements they were to evaluate, rating them in response to the Likert scale

on what they thought. The statements included were:

• The topic in the online self-instructional video were relevant to me

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• The online self-instructional video content was organized and easy to follow

• The online self-instructional video experience will be useful in my work

• The time allotted of the online self-instructional video was sufficient

The third section asked the participants to evaluate the following statements as each

relates to the Just-In-Time Content and Self-Help Articles of the Blended Learning Module.

There were a total of three statements they were to answer, rating them in response to the Likert

scale on what they thought. The statements included were:

• The Just-In-Time content provided me with important information to be able to

produce NPR reports

• The location of this content was easy access

• The Self-Help Articles were helpful

The next three questions were open-ended questions which dealt with respondents

feelings towards the training. The questions included:

• What did you like most about this training?

• What aspects of the training could be improved?

• How do you hope to change your practice as a result of this training?

A Likert scale was again utilized in the last section, requesting the participants to indicate

their level of agreement with the following five statements:

• Participating in the blended learning module was a good use of my time

• I would recommend this training to others in my department

• The Blended learning Module provided me with an important skill to do my job better

• Should this type of training be continued for NPR Report Writing

• Should this type of training be used to learn other aspects of my job

32

Management

Infrastructure

Management of a blended learning course includes things such as organizational structure

and work-flow to manage multiple deliver types. Managing multiple delivery methods takes

more effort than delivery of a course in one specific delivery type. Infrastructure requirements

were consistently monitored to make sure that the blended learning course was successful.

Scheduling and Notification

Management of scheduling and notification of the blended learning course was done

utilizing Microsoft outlook email. During each phase of the blend, an email was produced

announcing the next phase of the blend and when they needed to have it done. See Appendix L:

Email Communications. This kept the project on track and the communication lines open.

Resource Support

Online Content

Making sure that the online content is up-to-date and relevant is an ongoing process. As

more up to date content is collected, it will be disseminated in the shared folders assigned to the

blended learning module. It is accessible by everyone in the IT department.

Mentoring

As more IT staff learns how to create NPR reports, there will be a need for more mentoring and

coaching. A group of subject matter experts have been asked to fulfill the mentoring capacity.

Mentoring or coaching can occur in person, via email or online chat system.
33

Ethical

Considerations

There were considerations into the ethical stance on developing a blended learning

course. Considerations such as needs of the disabled, equal opportunity, cultural diversity and

nationality were addressed.

34

Section IV. Results of the Study

The blended learning module Creating Your First NPR Report was provided to the

participants over a two week period. Each blend was introduced through a series of scheduled

emails to the participants which provided necessary information on what to complete. The face-

to-face instructor-led class was held in the training room with thin clients available for them to

use to connect to Meditech’s software. The participants received a printed copy of the

PowerPoint slides and just-in-time handout to help them with this portion of the training. The

introduction and the two modules in the face-to-face instructor-led class were completed in two

hours and all of the learning goals were realized. The participants finished the class by creating

the required NPR report. Two days later, they were then engaged with the online content self-

instructional video that helped reinforce the learning from the classroom setting. Positive verbal

feedback was received. Last, the just-in-time content including self-help research articles was

disseminated to them. Again positive verbal feedback was received. The post survey link was

then emailed to the cohort asking them to complete by the end of the day. Everyone in the

cohort seemed very receptive to the whole process.

Summary

The participants in the cohort were very open to the aspect of needing additional

knowledge of NPR report writing and wanted to update their skills. The goals and objectives for

the course were all met in the following way with one or several of the blends.

• Will be able to recognize and articulate the foundational assumptions and Data

Procedure Module (DPM) File structures of Meditech’s report writing functions

o Goal met in the face-to-face instructor-led class. Module 1 – Data Storage

• Will have increased knowledge of NPR report writing

35

o Goal met in the face-to-face instructor-led class after finishing Module 1 and

Module 2. This goals was also met via the online content and just-in-time

content

• Will be able to utilize Meditech’s report writing online documentation

o Goal met with the introduction to the online documentation in the face-to-face

instructor-led class during Module 1 – Data Storage

• Will be able to write an NPR report using Meditech’s NPR report writing tool to meet

a specific departmental need

o Goal met at the conclusion of the face-to-face instructor-led class Module 2 –

Creating and Editing NPR Reports.

The participants continued through the rest of the blended elements finishing up with the

post survey. The assessment and gains in skills and knowledge was quite positive.

Results and Conclusions

Informal

One informal evaluation was from instructor perception in the face-to-face instructor-led

class. The researcher noticed several times in the face-to-face instructor-led class that

participants had questions on what was being presented. Sensing from their body language that

they did not comprehend, the researcher immediately stopped and asked “Can you see what I am

talking about?” at which time they would respond with a simple “No, can you explain it again?”

The researcher believes that these types of interactions were important for knowledge transfer for

those who are kinesthetic learners.

Other informal methods of evaluation continue even today with a constant open

communication of questions and answers on different aspect of NPR report writing. This
36

communication includes not only what was covered in the instructional modules, but other

aspects of NPR report writing. The researcher believes that additional NPR training should be

pursued so that they will have more training and knowledge in other aspects.

Formal

More formal methods of evaluation of the face-to-face instructor-led class were the actual

performance and production of the NPR report.

Post Survey

The post survey results of the blended learning course were conclusive that the cohort

agreed or strongly agreed to almost every aspect of the blended learning course. See Appendix

M: Post Survey Results.

The results show favorable for the nine statements on evaluating the face-to-face

instructor-led portion. 66.7% strongly agree with each statement and 33.3% agree with each

statement. One statement was skipped by one respondent that asked if the trainer was well

prepared.

The second set of four statements about the online self-instructional video content was a

bit discouraging to the researcher. 66.7% strongly agreed with all of the statements, 16.65%

agreed and 16.65% neither disagree nor agree. What does this tell the researcher? It may

indicate that the respondent who marked the statement on the Likert Scale with a neither disagree

nor agree possibly could have had problems with the online video. The respondent may had

problems with opening and viewing the video or possibly not having enough time to view it.

None-the-less, the scores for this section indicate that follow-up is needed with the respondents,

either by email or group conversation to discuss the online self-instructional video content.
37

The third set of statements about the Just-in-time content and self-help articles were

66.7% strongly agree and 33.3% agree. This gave the researcher the indication that they would

use this favorably in the future.

The next three questions were open-ended questions that dealt with feelings towards the

training. For the first question on what did you like most about this training, there were two of

the three cohort respondents with one response simply stating that they liked “the one on one”.

The other response stated “The instructor was very knowledgeable about the subject. She

explained the material clearly and made it easy to understand and learn”. The second open-

ended question about what aspects of the training could be improved there were again just two

out of the three cohort respondents. The first one put “more one on one” and the second stated

“Nothing, the training was fantastic. The trainer followed up after the training class with more

material on the subject to help keep the information fresh.” The last open-ended question on

how do you hope to change your practice as a result of this training was responded to by one of

the three participants. Their response was “I am completely new in this field. I will now be able

(to) write successful NPR reports using the methods that I learned.” Reflecting on the responses

to the first two questions where the respondent answered “one on one” and “more one on one”,

leads the researcher to believe that this respondent learns by demonstration and hands-on. Their

main objective was to be able to have an open dialog during the face-to-face instructor-led

classes to help them understand better. The researcher feels that having a smaller class, like this

study cohort of three people, could be a success factor in others.

The last section asked them to evaluate the five statements for overall satisfaction. The

respondents answered with a 66.7% strongly agree with the statements, 22.2% agreed and 11.1%

neither disagree nor agree. The researcher found the 11.1% result to be troubling in the fact that
38

one of the three cohort respondents neither disagree nor agree with the statement about if the

blended learning module provided them with an important skill to do my job better and the

statement about should this type of training be continued for NPR report writing. This result

gave the researcher an indication that this employee was disengaged, possibly because of not

seeing the benefit of the training towards one of the job requirements they were hired to do. In

order to adjust this attitude, the researcher will need to make sure that it is stressed to IT staff,

especially if they are systems analysts that this skill is part of their job descriptions and they need

to know and learn it. For other IT staff, it will not be so important for them. As for the other

disengaged answer whether this type of training be continued for NPR Report Writing, the

respondent may not be able to see the value in having any training, let alone a blended type of

learning. However, the very next question the same respondent agreed to the question on should

this type of training be used to learn other aspects of my job.

While technology of learning tools and delivery media continues to change and advance,

there is one thing that is certain: Organizations such as the regional hospital and particularly the

IT department favor blended learning models over single delivery style programs.

Recommendations

Based upon the results of this study, the researcher has identified the following

recommendations:

• The continued development of blended learning modules for NPR report writing

• The blended learning module developed for this study can be used as a template for

future blended learning modules in other areas of interest or need

• Given the time constraints of participants of the blended learning module, it may be

worth considering delivering the learning content in smaller chunks of time

39

The researcher concludes that in order to fully understand if IT staff learns better with a

blended learning format than another, the study should be conducted with the delivery of the

same content in a completely online learning environment. Comparisons between the two types

could then be done with results that would show which learning environment would be the best

for IT staff.
40

References

Adams, J. (2013, February). Blended learning: Instructional design strategies for maximizing

impact. International Journal on E-Learning, 12(1), 23-44. Retrieved from

http://www.editlib.org/p/35484

Collins, P. T. (2011, December). An insider's view to meeting the challenges of blended learning

solutions. Retrieved from ASTD - T+D Magazine:

http://www.astd.org/Publications/Magazines/TD/TD-Archive/2011/12/An-Insiders-View-

to-Meeting-the-Challenges-of-Blended-Learning-Solutions

Hofmann, J. (2011, March 24). Soapbox: Top 10 challenges of blended learning. Retrieved from

Training Magazine: http://www.trainingmag.com/article/soapbox-top-10-challenges-

blended-learning

Hovis, S. (2012, May 7). Developing capable leaders through blended learning. Retrieved April

12, 2014, from ASTD: http://www.astd.org/Publications/Magazines/TD/TD-

Archive/2012/05/Developing-Capable-Leaders-Through-Blended-Learning

Khan, B. (2014, March 30). Badrul Khan. Retrieved April 14, 2014, from badrulkhan.com:

http://badrulkhan.com/

Meditech. (2014, March 23). About Meditech. Retrieved from Meditech:

http://home.meditech.com/en/d/newmeditech/homepage.htm

Singh, H. (2003). Building effective blended learning programs. Educational Technology, 43,

51-54.
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APPENDIX A: Example NPR Report

42

APPENDIX B: Pre-survey Email

43

APPENDIX C: Staff IT – NPR Knowledge Survey

44

APPENDIX C: Staff IT – NPR Knowledge Survey (Continued)

45

APPENDIX D: Staff IT – NPR Knowledge Survey Results

46

APPENDIX D: Staff IT – NPR Knowledge Survey Results (Continued)

47

APPENDIX D: Staff IT – NPR Knowledge Survey Results (Continued)

48

APPENDIX D: Staff IT – NPR Knowledge Survey Results (Continued)

49

APPENDIX E: PowerPoint: Introduction

50

APPENDIX F: PowerPoint: Module 1–Data Storage

51

APPENDIX F: PowerPoint: Module 1–Data Storage (Continued)

52

APPENDIX F: PowerPoint: Module 1–Data Storage (Continued)

53

APPENDIX F: PowerPoint: Module 1–Data Storage (Continued)

54

APPENDIX G: PowerPoint: Module 2–Creating & Editing NPR Reports

55

APPENDIX G: PowerPoint: Module 2–Creating & Editing NPR Reports (Continued)

56

APPENDIX G: PowerPoint: Module 2–Creating & Editing NPR Reports (Continued)

57

APPENDIX G: PowerPoint: Module 2–Creating & Editing NPR Reports (Continued)

58

APPENDIX G: PowerPoint: Module 2–Creating & Editing NPR Reports (Continued)

59

APPENDIX H: Online
nline Video Self
Self-Learning
60

APPENDIX I: Just-in-time Handouts

61

APPENDIX I: Just-in-time Handouts (Continued)

62

APPENDIX J: Self-Help Article Example

63

APPENDIX J: Self-Help Article Example (Continued)

64

APPENDIX K: Post Survey

65

APPENDIX K: Post Survey (Continued)

66

APPENDIX K: Post Survey (Continued)

67

APPENDIX L: Email Communications

68

APPENDIX L: Email Communications (Continued)

69

APPENDIX L: Email Communications (Continued)

70

APPENDIX M: Post Survey Results

71

APPENDIX M: Post Survey Results (Continued)

72

APPENDIX M: Post Survey Results (Continued)

73

APPENDIX M: Post Survey Results (Continued)

74

APPENDIX M: Post Survey Results (Continued)