Flipping the Virtual Classroom: A Multimodal Approach to Telehealth Competency Development

Concurrent Session 1

Session Materials

Brief Abstract

As the “typical” classroom shifts from physical to virtual, how can we optimize time apart and together? Learn how one program blends self-directed eLearning, interactive webinars and virtual simulations to develop nurse practitioner students’ telehealth competency. Discuss strategies for moving away from lecture-style webinars to maximize interaction and experiential learning.


Dr. Laurie Posey specializes in instructional design, online and blended learning, and the use of technology to support all aspects of health professional education. Her research and scholarship focuses on eLearning best practices, active- and authentic learning strategies, collaborative learning, continuous quality improvement, online simulation, and telehealth-enabled education. She is the Director of the Nursing Education Certificates program at the George Washington University School of Nursing, and teaches in the areas of Instructional Design, Teaching with Technology, Knowledge Management, and Health Information Technology. Dr. Posey was the Principle Investigator for two grant-funded studies investigating the use of online and telehealth technologies to provide distance learners with opportunities for real-time, authentic practice and assessment through virtual Standardized Patient (SP) encounters. The first study funded through GW's Cross Disciplinary Research Fund is developing and pilot testing a Virtual Standardized Patient Portal that will integrate an open-source Electronic Health Record (EHR) into the Adobe Connect web-conferencing platform. The second study funded by the National Council of State Boards of Nursing's Center for Regulatory Excellence will compare the educational outcomes of face-to-face and telehealth-enabled SP encounters. As the former Director of Instructional Design for the School of Nursing, Dr. Posey has supported faculty in the use of innovative pedagogical approaches to online teaching and led the design and development of several grant-funded eLearning programs including Nurses on the Frontline: Preparing for Emergencies and Disasters (nnepi.gwnursing.org); the Graduate School Bootcamp (bootcamp.gwnursing.org); the Geriatric and Palliative Care Curriculum (gepaconline.gwnursing.org); and Interprofessional Care of People with Multiple Chronic Conditions (ipcmcc.gwnursing.org). She was the Principle Investigator for the Teaching and Transforming through Technology (T3) program, through which the SON’s Accelerated Bachelor of Science in Nursing program transitioned from a face-to-face to blended learning format. Dr. Posey is an accomplished instructional designer with 20+ years of experience designing and developing eLearning programs for academia, government, and industry. Prior to coming to GW, she served as Deputy Director for the Robert Wood Johnson Foundation’s Partnerships for Training program, which used distance education to educate Nurse Practitioners, Physician Assistants and Certified Nurse Midwives in underserved communities.
Dr. Pintz is a Professor at the George Washington University School of Nursing. Dr. Pintz has published and presented both nationally and internationally on the use of educational technology to enhance graduate nursing education, interprofessional education, on the characteristics of hospital-based nursing research programs, and the self management of chronic illness. Dr. Pintz was awarded the National Library of Medicine Fellowship in Biomedical Informatics in 2007. In 2010, she received the GW Bender Teaching Award and in 2013, she was the recipient of the Sigma Theta Tau International Educational Technology Award and the Best in Technology Award. She is a fellow of the National Association of Nurse Practitioners and the National Academies of Practice. She is an evaluator for the Commission for Collegiate Nursing Education Accreditation Program and Middle States Commission on Higher Education. In addition to her faculty activities, she is a board-certified family and women’s health nurse practitioner.

Extended Abstract

Does blended learning require a physical classroom component? Upon posing this question to attendees who’ve lived through the COVID-19 pandemic, we predict a resounding “no.” Although blended learning has historically been defined as education that includes both online and traditional face-to-face classroom components, as the “typical” classroom has shifted from physical to virtual, our definitions of blended learning must also shift. Rather than focusing on place, it is time to focus on learning.

A central premise of the flipped classroom is that lecture is not the best use of in-person time. This concept guided the design of an innovative educational program through which nurse practitioner (NP) students are learning to use telehealth technologies and consider social determinants of health (SDOH) to optimize care for people who may have chronic health issues or lack access to care due to location or other barriers. The term “telehealth” encompasses the use of videoconferencing, mobile health and remote monitoring technologies in healthcare delivery (HealthIT.gov, 2019). SDOH refers to the “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes” (Centers for Disease Control and Prevention, 2021). Using telehealth technologies to deliver care remotely and consider SDOH while addressing a wide range of health issues is a complex competency that is best supported by a multimodal approach.

The educational program includes three types of complementary learning experiences to support students’ competency development. Like a traditional flipped classroom, students first complete self-directed eLearning “primers” that provide foundational knowledge related to SDOH in rural and urban communities, conducting an effective telehealth visit and integrating mobile health and remote patient monitoring data into the care process. After completing each eLearning primer, students participate in a synchronous, experiential learning webinar designed to enable faculty-student and student-student interaction and guide application of new knowledge. For example, students view and critique expert role plays and videos of telehealth encounters; practice introducing themselves as if conducting a telehealth visit; share experiences using mobile health applications; and present and discuss cases from their clinical experiences.

The eLearning primers and experiential learning webinars prepare students for participation in simulated telehealth encounters. During these real-time virtual visits, students meet with Standardized Patients (SPs) representing patients from urban and rural underserved communities with varied SDOH and chronic and/or behavioral health conditions. The SPs are carefully trained to portray patients’ characteristics in an authentic and consistent way. Following each encounter, the SPs provide students with feedback from the patient perspective, and faculty observers engage students in a reflective debriefing. Each student participates in two or three telehealth simulations, allowing them to practice and develop their telehealth competency over time.

Evaluation findings indicate the program is achieving positive results. Scores on the eLearning primer quizzes indicate most students achieved the necessary foundational knowledge, with an overall average quiz score of 82%. Students’ evaluations indicate they value each type of learning activity. Ninety-two percent of students who completed the end of program survey strongly agreed the learning modules increased their knowledge and 89% strongly agreed they would be able to apply their learning in clinical practice. Comments from the student evaluations indicate they enjoyed the interactive, experiential nature of the synchronous webinar sessions, in particular the peer-to-peer clinical case discussions. Ninety-four percent of respondents strongly agreed that the simulations helped to prepare them to deliver telehealth in the future, and 100% believed the SP and faculty feedback was valuable.

Starting with our opening question, this session will engage participants in an interactive discussion of best practices for combining self-directed eLearning and person-to-person experiential learning to support learner achievement of complex competencies. We will use a variety of creative polling strategies (e.g., think-pair-share, quiz questions, word clouds) to glean audience knowledge and insights and prompt active, ongoing participation. Using the educational program as an example, we will discuss approaches for moving away from lecture-style webinars to maximize interaction and experiential learning. Participants will leave the session with an expanded view of blended learning, an understanding of how different teaching approaches contribute to the learning process, and concrete strategies that can be adapted to optimize learning in asynchronous and synchronous online environments.