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What We’ve Learned about Note-taking in Continuing Education

If we go all the way back (now nearly 6 years ago) to the original Learning Actions research project, one of the first insights gained was that note-taking is a nearly universal behavior that clinician-learners rely on to support their learning process. In fact, from my initial interviews I found that nearly 85% of clinician learners acknowledged that their learning process begins with taking notes. Interestingly, the other 15% of learners – those who claimed that they didn’t actively take notes during their continuing education experiences – acknowledged that they never developed an effective note-taking strategy and that over time they simply gave up trying!

One way to look at the Learning Actions Model is that it simplifies and centralizes the critical actions learners rely on – actions that while necessary, are largely unevolved. Over time we have now validated the model in tens of thousands of clinician learners – this is how we now know how well it works: Learners learn more when their learning actions are optimized!

As our data sets have grown, we have been able to dig more deeply into the intrinsic complexity and the inter-connectedness of each learning action. One of the more recent findings we’ve uncovered is that the notes that clinician learners take appear to come in three flavors: linear, tangential, and derivative. 

Linear notes = a learner records exactly what was shared by faculty.
Examples may include jotting down specific diagnosis criteria, details about new trials, specific case conclusions that faculty present, or new dosing information. From a learning analytics approach, linear notes point to areas of the content that learners were ‘moved’ by and the content of the note often provides insights into understanding, agreement, or confusion.

Tangential notes = a learner relates what is being shared by faculty to some deeper thinking or plan of action.
Examples may include connecting what they are hearing/seeing to a recent patient, to a forthcoming patient, or to a case a peer may have recently had. They may record an action that they want to take, for example a desire to share some nugget with their peers or care team. Or they may relate new research to foundational or prior research exploring similarities or contradictions. From a learning analytics approach, tangential notes appear to represent higher-level or deeper thinking; again, the content of the note often provides insights into specific actions or barriers to action.

Derivative notes = a learner records thoughts that seem to have no obvious relationship to what is being shared by faculty.
Examples may include just about anything under the sun 😉 Seriously though, they often seem out of left field and from a learning analytics approach I haven’t quite figured out what to do with tangential notes…and certainly not at any meaningful scale. For now, I am left considering these as outliers and generally exclude them from any analysis.


In terms of proportionality of the three types of notes, I haven’t rigorously quantified them yet but quick analysis suggests that the breakdown is somewhere in the ballpark of 60-70% Linear, 20-30% Derivative, and <5% Tangential.

In terms of importance of the three types of notes, I currently look at it this way: Tangential >> Linear >>>>>>> Derivative.

Over the coming months I will undoubtedly be working with our Partners and digging further into our data sets. We will be looking for new ways to nudge note-taking and we will be rolling out new means by which notes can be taken (eg., audio or visual capture married to a note). As this research evolves, I will try to share more about our general lessons!

In the meantime, take a moment to think about the notes you take, how you hope to use them, and how (at times) they go to waste. As I journey down the path of Learning Actions research, I continue to be fascinated by how much we still have to learn about learning. 😉

Written by

Brian is a research scientist and educational technologist. He helped transform Pfizer’s Medical Education Group and previously served in educational leadership roles at HealthAnswers, Inc.; Acumentis, LLC.; Cephalon; and Wyeth. He taught graduate medical education programs at Arcadia University for 10 years. Dr. McGowan recently authored the book "#socialQI: Simple Solutions for Improving Your Healthcare" and has been invited to speak internationally on the subject of information flow, technology, and learning in healthcare.

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