When a seemingly well-designed continuing education program doesn’t have the effect on clinicians’ clinical behaviors that we aimed for, what do we seek to adjust to make it more effective?

Continuing education is critical for healthcare professionals to practice evidence-based care. To see meaningful change in clinical practice, we must consider and plan for education that supports clinicians in the environments in which they work and make decisions. What is needed for education to drive real, sustainable change?

Every big change starts with small actions toward a goal. However, not all actions and decisions provide the same impact. By applying social science to understand the contextual impacts on how learners learn, CPD professionals can help clinicians optimize the impact of each educational step. By consciously applying social science principles to understand how learners truly integrate new knowledge and why they act (or don't act) within their complex environments, we are better enabled to strategically plan learning designs that build clinicians’ knowledge and skills that will support them in practice. With this approach, we will design CPD experiences that do more than fill knowledge gaps: We will build education that actively empowers clinicians with relevant support to translate learning into consistent, impactful and, ultimately, higher qualilty  patient care.

A noted social scientist, Pierre Bourdieu, wrote extensively on the importance of considering the impact of structures (i.e., social, organizational, political, etc.) as drivers of individuals’ decisions: Individuals, including healthcare professionals, make choices within the constraints of what they are empowered and able to do.¹ Clinicians typically work within healthcare settings with clinical gaps driven by a complex interplay of systemic barriers, entrenched processes, preference-sensitive decision making, genuine knowledge or skills gaps, misaligned incentives, and even gaps in directly applicable evidence. This is precisely where social science offers a powerful lens for maximizing our impact.

Further, we know individuals learn from and are affected by their social environments. Mark Granovetter examined the role of acquaintances (or weak ties) as facilitators of access to new information, to complement close, strong relationships (or strong ties) as resources for practical insights and perspectives.² [see previous article on this topic]. CPD professionals should leverage these social dynamics to design medical education programs that provide vital practical guidance to overcome system and process barriers, and, crucially, to offer the sustained support required to translate new understanding into consistent, impactful clinical practice behaviors and decision making.

What are some practical ways to apply these social science considerations in CPD learning design?

Enable clinicians to learn from and with their peers.

• Leverage the power of social networks to impact clinicians’ decision making and actions. In education design, offer opportunities for healthcare professionals to share, reflect and gain insights and perspectives from peers and other healthcare professionals, including members of the interprofessional healthcare team. For example, technology tools can offer clinicians engagement and shared learning with professional peers. Education is more likely to stick when clinician learners trust information from competent faculty and peers as they are more likely to pay attention to, reflect, and take action on that knowledge.^3-5 The capacity to design and deliver compelling and effective online education has evolved immensely with technology innovations, and virtual education provides opportunities to leverage online networks of clinicians to offer the exchange of ideas and information to support effective peer-based learning.^6,7

Address barriers that challenge knowledge/skills application.

• When identifying the clinical gaps that we aim to close through education, carefully assess the impact of structural (e.g., systems and processes) and social (e.g., social structures and expectations) factors that impact healthcare professionals’ behaviors and decision making. Where possible, outline actionable solutions, which may include education and system- or process-based solutions, to support healthcare professionals in learning how to put their knowledge and skills into practice within their workplace setting. Consider education plans that address the interprofessional team — which will enable knowledge and skill building as a shared experience — to build social expectations and support for change and improved practice.

Combine these two factors within your education for multiplied impact.

• Open opportunities for healthcare professionals to solve sticky challenges by engaging with their peers and interprofessional team, such as learning from others how practical challenges have been tackled, to help spread success stories across disparate networks and clinical teams. In this way, solutions for improving care and outcomes are scaled through leveraging the power of social networks, including peer clinician networks.

Our social and structural environments are, without doubt, among the most powerful influences of our daily actions and, therefore, our growth and evolution. CPD professionals should consider how learning designs may effectively leverage social and behavioral science. As Gladwell notes, the stickiest ideas will always be ones that can become merged into the fabric of our environment and culture.⁸ As we design medical education, it is critical that we consider the social and structural impacts that clinicians must overcome to turn a “yes, I want to” to a distinct “yes, I will” commitment following an education experience. Clinicians who successfully put learning knowledge and skills into practice often have social and behavioral environments that support them to do so. Therefore, in service of clinicians’ more effective learning and, crucially, of patients’ improved outcomes, our CPD community must broaden our lens to embrace the profoundly social dimensions of professional learning.

This article is the second in a series of articles exploring practical applications of social science theory and frameworks to CPD design and implementation to collectively broaden our shared understanding.

References:

1. Bourdieu P (1977). Outline of a Theory of Practice. Cambridge University Press, Cambridge, UK.
2. Granovetter M (1973). The Strength of Weak Ties. American Journal of Sociology, 78, 1360-1380.
3. Pelz DC & Andrews FM (1966). Scientists in Organizations: Productive Climates for Research and Development. John Wiley and Sons, New York.
4. Burt R (1992). Structural Holes. Harvard University Press, Cambridge, MA.
5. Lave J & Wenger E (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge University Press, Cambridge, UK.
6. Rajkumar K, et al (2022). A causal test of the strength of weak ties. Science, 377: 1304-1310.
7. BBVA Foundation (2022). Interview with Mark Granovetter, Frontiers of Knowledge Award in Social Sciences. Accessed 5/26/2025: https://www.youtube.com/watch?v=IMDFajzyYsI&t=7s
8. Gladwell M (2002). The Tipping Point: How Little Things Can Make a Big Difference. Back Bay Books.

Caroline O. Pardo, PhD, CHCP, FACEHP, is the founder of Table Talk on Health and a consulting advisor for IAS LLC. She is a thought leader in human-centered and healthcare professional and patient interventions to improve outcomes, with specialized expertise in the application of clinical, social science and research methodology to the design, execution and evaluation of comprehensive education, training and implementation science initiatives.