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Learner Experience Design at Carnegie Mellon

Today was our first meeting. To set the stage, we played 2 games.

The first had us play a sort of personal-experience bingo, trying to find classmates that were picky-eaters, had been on a boat, liked warm colors etc… This was not an easy game, as it required picking the right question to ask the person that’s in front of you. It’s easy to know these things kind of surface-level details about yourself, but to determine who’s been on a boat just by looking at someone requires judgement of a very superficial nature. I think the point of this activity was to get us to recognize that sometimes, judgement and instinct are an important part of perception. I found that my questions were often fruitless when I was asking a bit at random, but I later changed my pattern to gather some information about the person (by looking and judgment-forming) which lead to better results. Conversely, this games is about how what we keep as internal ideas or knowledge do manifest themselves in reality, either by the way we look or dress, or by how we hold ourselves and act.

The second game had us answer UX trivia questions in a group. I also think this game dealt with judgment pretty directly as we as a team had to weigh each others often random guesses against a number of unseen attributes, like confidence in the answer, whether or not the group is on the same page, or credibility of the answer-er. The short time-span made us have to act and judge quickly, discerning right from wrong and who among the group has more confidence in their answer and if that confidence is misplaced or not.

Today, Ellen from UPMC visited and discussed readmission in further detail and gave us a sense for the problem space. I’m starting to have a better sense of all the angles through which this problem manifests, I feel like I need to spend more time thinking and unpacking the problem. Ellen was clearly knowledgeable, though I often feel that having a Subject-Matter Expert (SME) deliver information on a problem is not the best way to deliver. SME’s have too much information connected in pre-existing knowledge structures, that we as novices can’t “get” unless given carefully. I do need a better walk-through, though I haven’t yet found a good “user-friendly” description and breakdown of the problem. Though I did find this…

I felt this reading was a good one as we’re talking about perception and judgement, at least through the activities in Day 1. Hopefully we’ll spend time engaging with the topics that Adams has discussed. I kind of wish that Adams spent as much time on the other blockers as he did on Stereotypes. The last few blockers only got about a page or so each, which makes me wonder if he devalues them or sees them as more easily identified. I also think he could have done some job of relating them or perhaps providing examples of why one blocker may be the problem than another in given situations. His suggestion up front, “Perhaps the best way of helping you overcome perceptual blockers is to talk about some common and specific ones,” does not suggest to me a good handle of learning science. I think I am slightly more aware of a perceptual blockers, but his description of them does not lead to me being able to defeat these blockers, especially as he has not offered much in the way of solutions or recommendations for breaking blockers.

Today we spent class going through an example of each Conceptual Blocker. We drew pictures of common items and pointed out how we all drew them in similar states, leaving out unseen details and momentary versions, redesigned water bottles, and thought about different perspectives on a problem — this will be crucial to our task as there will be a lot of different people involved in readmission. My favorite task of the day was breaking down a toaster into its “essential pieces” only to get rid of the most essential elements and try to rebuild it without those. I think this will be a useful tactic for validating approaches and designs, if by taking out something we think is essential, we can find a work around, that piece may not be as essential as we think. Alternately, this can help think about different ways to solve the same problem. Overall, I liked doing these activities and felt they helped me see good use-cases and approaches to break the blockers.

We finished up our conceptual blocker practice and started applying block-breaking strategies to the problem space. I found it hard to distinguish which blocker I’m actually using — depending on how the blocker is phrased it could switch from being a stereotype to a poor problem delimitation. For example, it could be a stereotype of mine that only nurses are part of the problem, or that may be poorly delimiting the problem space to only nurses. I’m not yet sure of 2 the trade-offs of thinking through each individual blocker.

Today we discussed “learning curves” which were more of a discussion of thresholds and ceilings than learning in my opinion. In Tools for Online Learning we discussed tool buy-in with these two terms — threshold is sort of the effort needed to see the first benefit of a tool and ceiling is the maximum benefit of a tool. In our case, we’re designing experiences which may or may not be tools, and our experience will have its own sense of threshold and ceiling.

Our 4MAT personality test was great. I personally enjoy these types of tests, Myers-Briggs, Emotional Intelligence, Work/Conflict Styles… They help me learn about myself and how I see/do things. What was most interesting about 4MAT is that it not only categorizes personality types, but includes us in a process and now only shows how we learn best but what we prefer to think about and do. Mine was so fitting, I am definitely a Quadrant 4. I’ve been seeing how I’ve asked “What If?” in a number of other class projects and my own personal life.

In prior courses, particularly Educational Goals, Instruction & Assessment; and E-Learning Design, Principles and Methods, we spent a lot of time discussing the value of goals and goal-centric education. Using Bloom’s Taxonomy for goal writing is a great way to phase goals as something people can do, though the “Sophistication” labels in this graph would not make particularly good verbs for goal specification.

However, I’ve spent little to no time discussing the “Proficiency” axis. In E-Learning, we learned about the ABCD method for goal specification:

I consistently find Degree to be the most poorly defined aspect of this method. Looking at the examples: “in three paragraphs” and “including identifying and formulating relevant legal theories, generating alternative solutions and strategies”. These are both “Degrees”. I personally felt I was provided with little guidance as to how to stratify degrees and categorize them into levels of specificity. But Dirksen’s graph provides some insight, there are layers to Degree taking form of deeper autonomy.

Groups are formed now and I’m excited to work with some non-METALS folks. I’ll get to be the voice of learning science for the project, and it seems my group members are highly interested in health care. You can see our group documentation unfold here: https://medium.com/@julianaschnerr/lxd-group-documentation-e2ce95e137a4.

Today we did some problem mapping. Our group took a broad, systems-style approach. This kind of big-picture thinking is something I particularly enjoy. Hopefully my group-mates will be more detail oriented than me! Our problem system revolved around uniting UPMC and the community through a layering of stakeholders. For the sake of the activity we chose to isolate UPMC, the Patient and Caregivers as stakeholders. It’s interesting to shift perspectives to frequently, brainstorming for each of the stakeholders at the same time.

We later went over Bloom’s taxonomy which I’m been acquainted with in several previous courses. This taxonomy, among others, breaks “knowledge” down into different components like Memory or Skill and provides good adjectives to use when writing goals for each type of task. While we have not chosen a problem yet, evaluation or measurement of learning goals is always a tricky problem. Using Bloom’s taxonomy and other instructional design techniques can help.

For sake of class we chose to look at lack of evaluation methods to prove patients’ understanding of their discharge plan. Breaking down this problem resulted in us defining several states of the situation — Current and Preferred, with the Bridge between them to come later.

Ambrose’s discussion on motivation was interesting. In a prior course, we touched on motivating factors in a learning experience by discussing a Hook — what hooks the learner in and holds their attention? It can be a variety of things from subject matter itself to use of personal stories by the instructor. Ambrose shares some similarities particularly by chaining motivation with goals. Goal directed education has come up often in my coursework.

Again, related to the Hook part of instructional design, attention and motivation seem related to me. The elephant analogy was an interesting one, and a good comparison to how strong our unconscious minds are. Harnessing that unconscious for learning requires special attention.

The second-to-last point in this summary is one that is of particular interest to me. Extrinsic mechanisms can undermine and destroy any intrinsic mechanisms, but in particularly challenging learning environments (like readmission in hospitals…), learners likely need more extrinsic mechanisms to motivate. Fading these mechanisms so intrinsic mechanism form to replace is a very careful process.

Today we played Musical Chairs. Didn’t expect to be able to say that in grad school…

Relating back to Ambrose 3, we looked at Musical Chairs through a lens of motivation, particularly how some people’s mentality changed over time. This was attributed largely due to an early success and a sense of attainability. As certain classmates made it though the rounds, being in the finale became more attainable — more visible. As Ambrose broke down the components of value, we felt that Musical Chairs has little to do with “Instrumental”, that is the sense that participation will be beneficial for the future. We did some value break-down of our problem through the lens of Caregivers. We’re becoming more and more vested in the problem of plan understanding, and bringing Caregivers into the mix offers some potentially interesting angles as they’re not the ones who have to do the lifestyle change.

We spent today diving into the Magic Circle, an experience design analogy suggesting how people enter a state of play while participating in an experience. I see a lot of familiar elements to my Design for Educational Games course where we’ve discussed how a game is an imaginary situation that immerses the player. This state change has been shown to facilitate learning, making the player more receptive to information.

Our Magic Circle started with some of the elements from “Bridging the Gap” last week. I also started drawing parallels to backward instructional design and game design frameworks.

I think we would benefit from spending more time doing a Current v Preferred state description of our problem and then coming back to the Magic Circle to see how we can bridge the gap with experiences. Another important note that came up today was that our experience still intends to influence the patient, but we’ll be quite far removed as we’re designing an experience for caregivers. Us →Experience →Caregiver →Patient. It’s a few jumps.

Today we discussed memory — how do people know things? What mechanisms help them to maintain information? Ambrose discusses mental models and structures, that is information get stored though connections but the way those connections get formed and how “nodes” of information connect with each other makes a big difference. I like to think of a structure like a framework, a pattern that can be found when you know to look for it. In this way, we can call learning the encoding of a pattern of information into the mind.

The way we think about genealogy, politics and cooking are all patterns — trees, spectrums and step-by-step procedures respectively. Each of these is a framework, some more visual than other. Getting people to connect family members through a tree-lineage takes showing that image and drawing the lines. If we were going to teach how to do this, we’d want students to do the same and actually map out family members.

Moving on to our UPMC problem, our group chose to isolate dietary changes required by the patient. We felt that there a lot of memory components to change of diet, though we’re unsure of the real diet conditions that a readmission case would warrant. To get a better sense of how memory can be translated into a prototype-able idea, we started with diet. There are also a lot of chronic problems (often readmission cases) that would likely warrant diet changes such as heart problems.

Some memory-related components of diet we came up with include:

These could easily be turned into valid learning goals with some verb’s from Bloom’s Taxonomy’s Remembering category. A few examples include:

These would need a lot more description to become solid goal definitions, but they’re suitable for exploratory ideation. Moving on, we discussed the kinds of structures suitable for layering memory tasks into well defined mental models. Ambrose says that having and reinforcing an explicit structure of knowledge can help the learner build that structure for themselves and integrate the information properly. So we looked at the types of structures that would make sense for these memory components — a calendar for calorie tracking and food journaling, a T-chart (like pro/con lists) for differentiating foods. These common frameworks draw on existing models in most learners to build new layers of information.

To actually integrate these models into the learner’s mind, we discussed the need for a strong visual language and immersive experiences. We focused more on differentiating good from bad foods as it’s fairly straight-forward and can manifest in a lot of simple forms. Deciding that things like food pyramids were bad visual expressions, we moved a bit into how we could represent this with a person — how does the person feel after eating something? Maybe there’s a chart of a happy person or sad person?

For about a 10-minute prototyping session, we wound up really happy with the result. The doll could provide something to project empathy onto, could be customizable to better match the actual patient’s look, and have more than just diet — you could potentially have a life-size doll that you have to dress for practice, or have to give the correct pills at the proper times.

We’ve been slowly grappling with our own lack-of-concreteness in the readmission problem. As this is a hugely systematic problem, finding one piece to latch on to has felt arbitrary as we have done little research in the UX sense. No interviews, no observations, no contextualization…yet. We finally have a date to actually go in and visit a hospital to see the reality of the problem — Michelle and Juliana will be visiting a UPMC facility on March 1st. In preparation of that, we’ve done some planning (below) about the purpose of that visit so we know what we hop to get out of it.

We want to get a sense for a few things like how the patient appears to feel in response to a number of things, whether or not they’re accompanied, and how they learn about their discharge procedure.

Another class I’m currently taking is Design for Educational Games, taught primarily by Erik Harpstead with Eben Myers serving as a frequent guest lecturer. Eben is the VP of Design at SimCoach Games, an educational games company here in Pittsburgh.

During one class, Eben mentioned ever so briefly that he had done a project for UPMC and it sounded like readmission from his description. So I inquired and was right, SimCoach was contracted by UPMC to work on (a much more specific aspect) of readmission.

My group and I had been feeling like readmission was a bit abstract, our research has been the papers provided and when Ellen came and talked. We haven’t been to hospitals yet and feel a sense of intangibility, so I was hoping at the very least Eben could field this concern and provide some more background on readmission. I got more than that. Eben and I talked for about 45 minutes. He said that UPMC provided him with some very specific parts of readmission, particularly heart failure and some lung issue. After more and more research, and their being a games company, SimCoach developed a game for the patient to take care of a person going through similar conditions. For example, the patient would have to weigh their character ever so often, a recommendation common for those suffering heart failure.

Though I haven’t seen SimCoach’s final product, their patient-centric approach already sounds like the prototype we thought about for caregivers: an agent the learner has to take care of with the condition, be it a projection of the patient’s self or a reflection on dependent family members.

Overall, it was encouraging to hear Eben give his perspective on solving problems as complex as readmission. Hopefully, I can get Eben to come speak in class and show off SimCoach’s solution to our problem.

In class, we had some time to catch up with each other but as we had an extra meeting last Tuesday, we felt on the same page. Stacie had put up all of the theories we’ve learned to-date for us to reflect on. We thought about which might we want to revisit in the future and landed on the very first theory we tackled as a group — Mapping Stakeholders.

When we originally went through this activity, we were new to the problem and took almost the widest possible view of the system. Now that we’ve narrowed down somewhat, and certainly after we observe at the hospital, we’ll be able to have a much more granular look at stakeholders and their needs/wants/hopes/fears.

We also took a bit of time to strategize for next Tuesday’s talk with Kristen, our new UPMC contact. We want to have her answer as many questions as possible before we go into the hospital so we can either validate assumptions UPMC is making or find an un-explored problem area to target. Some questions we have for Kristen are below:

We’re hoping Kristen will help us scope down on the problem.

The rest of class today was a presentation from Suzanne Choi and Laura Rodriguez, two Design Master’s students who are also researching readmission at UPMC. They went through a lot of the insights they’ve found as the exact research they’ve done is confidential. Suzanne and Laura looked primarily at heart disease cases, the #1 cause of readmission cases. While we’re not certain we’ll be focusing on heart disease, several insights presented were broad enough to be applicable in many cases. In particular, I was struck by their discussion of self-perceptions.

The implications of this are that older patients will view the disease as a part of getting older and therefore is out of their control. This causes patients to feel like they won’t be able to do anything to fix their disease and as a result, will not follow their discharge care plan. I see this as highly similar to the concept of fixed and growth mindsets. These relate to learning, where in a fixed mindset, a student will feel like they cannot learn a new thing often because of personal meta-reflective views of them-self. For example, “I’m dumb so I can’t learn calculus” would be emblematic of a fixed mindset. On the contrary, a growth mindset is one in which students want to improve their skills and do so with a willingness to learn new things. “I don’t know that yet, but if I work harder I will” would be fairly typical growth mindset talk. In fixed mindsets, learners tend to focus too intensely on characteristics that are constructed by themselves — “dumb” and “smart” are both relative so calling or comparing yourself to one or the other can reinforce fixed mindsets where growth mindsets focus more of the actual learning tasks and pieces of information like a fact, skill, what they do and don’t know.

In this case, age is the fixed trait that patients are dwelling to much on, not realizing that they could focus more on the skills and habits they can use to improve their lives and stay as healthy as possible. Solving this would require a mindset intervention which is not something I’m particularly well versed on, but this discussion is bring up a lot of previous coursework. Tools for Online Learning has discussed when to plan a mindset intervention with relation to task-feedback; Educational Goals, Instruction and Assessments has spent time on meta-cognitive disposition changes (getting people to think about how and why they feel or act a certain way); and in Learning Media Design, the group I was in actually prototyped an app for assessing soft-skill changes over time.

Today we received a list of the priority issues as identified by UPMC. As we had been thinking mostly about a caregiver centric approach, we were a bit disappointed to see only patient-centered problems, though it’s understandable as to why. Patients are the focus of a hospital and that’s maybe why we’re interested in not patients, to give attention to the other parts of a patient-doctor interaction.

Our activity for the day was breaking down the problem statements and looking at teaching them through the 6 Facets of Understanding from Understanding by Design (UbD)— a book very dear to my heart as I spent all last semester learning from it. UbD spells out the backward design process, a curriculum development strategy, with the concept behind this being that making explicit what people should learn (goals) will help you know how best to prove that it was learned (assessments) and then help you know how best to teach that information (instruction). The 6 Facets comes from the instruction portion of the book, as a way of separating what it means to “understand” something.

The 6 Facets are:

In thinking about our problem space, we decided that abandoning caregivers would mean lost work for ourselves and lost opportunities. We agreed that keeping both parties in the mix would be interesting and motivating for ourselves.

Considering caregivers, patients and UPMC’s identified problems led us toward considering places where both caregiver and patient would need understanding, or where shifts in a relationship might take place. Often caregivers are direct relatives or loved ones of some kind, and the new-found medical needs of the patient put strain on the health of the relationship.

In situations like heart failure, a lot of lifestyle changes need to take place for the patient, and the caregiver often needs to become a bit of a doctor themselves creating tension between supporting the patient and enforcing treatments.

Thinking about the context shift, we started to unpack across the 6 Facets resulting in us thinking a lot about situations where a more squeamish caregiver could face difficulty, such as changing an IV or cleaning bandages.

There’s a lot of understanding that has to change between loved ones as new health-related tensions arise. Understanding how to change an IV (application) and understanding each other (empathy) are requirements for a healthy home life for a patient.

We focused today on Skill Acquisition, a very challenging aspect of experience design as it requires a lot of repetition and detailed improvements/feedback. Skills are difficult to acquire naturally as its easy to do the wrong thing or do the right thing the wrong way. Without an external agent intervening, people will continue to reinforce whatever they’ve been practicing.

We looked at 2 games in thinking about skills, Story Cubes and ReDistrict.

Story Cubes is a set of dice with various symbols on each side. The object is to roll them, and make a story out connecting all of the symbols. It’s a fun game that encourages a lot of creativity given the open ended nature of the symbols.

I had a difficult time calling this a “game” as a game typically has rules and objectives. Story Cubes didn’t have rules or a clear objective. It lead to a more “play”ful style of interaction as it was less directed and more chaotic. If it’s a game, then what are the goals? Create a story? Write a narrative? Connect the symbols? These are pretty broad goals which makes this game unlikely to really train any skills. It’s also not repetitive enough to reinforce skills. This could be used to form a more concrete learning experience, but as-is its quite loose.

ReDistrict was an online game where you have to draw district maps to accommodate local elections across a number of dimensions (population, political party, race…).

Again, I see this as not very game like. It’s a bit more of a simulation, as its pretty realistic and not very fun. There’s a high degree of challenge which disrupts a productive flow of the game. The skill in question is shaky too — is it redistricting? If it is, I don’t think that people use these kinds of interfaces to actually redistrict so I’d question the authenticity and therefore transferability. There’s also no task-feedback to help people understand which parts of the skill they’re doing wrong.

As for readmission, these cases present challenges to overcome or examples of possibilities. In terms of challenges, making sure that learning really happens is a big one which may or may not land well. You can have good intentions and design a cool experience, but the goals may misalign or be specified at the wrong level. However, there are clearly lots of ways people try to create learning experiences — simulations, toys, games, play, digital, analog, blended, and more. We could explore lots of options to think about what types of activities would make the most sense for the type of learning we’re trying to encourage. We’ll want to keep learning grounded in as realistic a scenario as possible and help patients and caregivers find a good way to train skills. Bringing feedback into the equation needs exploration, particularly for skills learning as that was the biggest failure of these two examples. And in our context, doing something incorrectly could have serious health ramifications.

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