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Teaching with QR Codes: Accessible Technology for the Novice Educator

Special Issue: Blended Learning Technologies in Healthcare

By Elizabeth V Schulz, Katherine M Ottolini / February 2023

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From elementary schools to graduate-level programs, the global pandemic forced virtual educational models into immediate demand. The vast array of options has been overwhelming for educators, especially those new to online education. The pandemic also drove educators to re-think traditionally in-person instruction such as procedural and equipment skills training [1]. Just-in-time training (JiTT) is a needs-based training model that provides learners on-demand knowledge when required. JiTT has been utilized since the beginning of the pandemic to educate large numbers of medical professionals, separated by time and location, on unfamiliar critical procedures [2]. Teaching in hospital environments with strict technical safeguards and regulations requires additional creativity to develop a flexible blended learning curriculum. During the academic year 2021–2022, we set out to develop an interactive equipment training curriculum for a target audience of highly specialized medical professionals and expand the capabilities of asynchronous learning. 


Our model merges the concepts of competency-based, time-variable training and electronic performance management systems (E-PMS). In competency-based, time-variable training, a learner must meet preset learning targets but is allowed time for continued competence development, as each learner will have their own timeline for competency achievement [3]. E-PMS aim to distribute information to all team members, not just selected individuals, and integrate long-term goals (e.g., information retention) [4, 5]. Our training module aims to combine a traditional skills checklist with novel utilization of quick response (QR) codes to provide accessible JiTT in a standardized and well-organized platform for our learners. In this article, we aim to share practical knowledge and advice on the framework, concept, and construction of a blended skills training curriculum, using ours as an example.

Educational Content and Intervention

We work in a U.S. Air Force Neonatal Intensive Care Unit (NICU) with a unique global neonatal transport mission. Our transport team is composed of physicians, nurses, and medical technicians who perform long-distance, fixed-wing, en route critical care. All incoming staff members to our NICU have experience in performing neonatal care but must undergo specialized transport equipment training to become members of the transport team.

At the inception of the course design, we aimed to identify a platform that fostered effective blended learning for equipment skills training in healthcare professions education. Blended learning combines in-person instruction with online or web-based tools [6]. Using a framework for course design, we developed a standardized equipment skills checklist and then recorded instructional videos demonstrating how to perform each step [6]. This new format allowed trainees to review learning materials and perform hands-on practice independently at their own convenience, replacing approximately 70-80% of face-to-face training with individualized learning and hands-on skills practice. An experienced transport team member then met with them in person and precepted them on performing the equipment skills checklist, providing corrective actions as needed. 

In the past, each incoming team member received apprentice-style, hands-on equipment training from an experienced transport team member. Not surprisingly, this teaching method led to a lack of standardization, with each person’s training depending heavily on their preceptor’s knowledge, which sometimes resulted in significant gaps or improper training. The global pandemic prompted us to re-evaluate our way of training new transport team members. It forced us to develop a standardized equipment skills training curriculum that was more accessible and easier to complete while staff members were already at work for their clinical shifts while limiting additional in-person interaction.

Given the target audience of staff members working in a high-stress, high-acuity, forward-deployed environment, time management and ease of use were important factors in the course design. In developing this curriculum, we faced technical barriers because several websites (i.e., Google Drive, Dropbox) and tools (i.e., USB drives) with the required volume to save video files were not authorized for use on hospital computers. Additionally, learners can only access military email via Common Access Card reader-enabled computers and posting military training materials to public videos sites (e.g., YouTube) is forbidden. This can make the process of accessing links for video-based training time-consuming and cumbersome for learners, especially for our team members who are typically completing transport equipment training on clinical work shifts between required patient care. We therefore turned to the use of QR codes to provide trainees with accessible JiTT learning materials in an organized, easy-to-read format (see Figure 1). Print copies of the training curriculum were displayed at the nurse’s station and next to the transport equipment, such that trainees could easily scan the QR codes on their smartphones or tablets in between patient care activities.

Figure 1. Example from our Neonatal Transport Equipment Training Curriculum.

[click to enlarge]

Rather than the previous format of long in-person training sessions, during which learners could easily experience cognitive overload and difficulty with knowledge retention, this curriculum was divided into discrete mini-modules with clear checklist items that were demonstrated in the accompanying five-minute training videos. Learners were also able to provide information on their skill development and feedback to instructors for ongoing course improvement via QR code links to online course evaluation surveys, also easily completed on any mobile device.

Content Value

As a course designer, QR codes can be easily created and incorporated into JiTT educational materials to make any web-based educational content readily accessible to learners. In Figure 2, we share practical advice for the creation, and break down into mini-modules, of a large curriculum into manageable pieces for the learner to absorb. Additionally, we review simplistic steps to create QR codes for these mini-modules, even for the novice educator. It should be noted we had limited knowledge on web-based course design and, quite frankly, limited tech experience at the onset of this project. Likewise, as busy physicians, our schedules demanded a platform that offered quick construction on a budgeted timeline but yielded a well-designed product. Taking these limitations into account, ease of development for the instructor was an important factor in addition to ease of use for the learner.

Figure 2. How to create video-enhanced mini-modules using QR codes.

[click to enlarge]

QR codes are increasing in popularity as educational tools, and health professions educators are beginning to incorporate them into medical education. Curriculums using novel QR code-based interventions in physician and nursing education have been well received by students [710]. In a recent study, Li et al. created QR-code linked clinical skills training videos for intern education [10]. Students who utilized the QR-code based video curriculum demonstrated improved performance on a clinical skills assessment, as well as greater satisfaction with their learning, compared to historical controls [10]. As our equipment training curriculum demonstrates, QR code-based learning interventions have the potential for broader applicability to JiTT related to technical and procedural skills-based education. In our curriculum, QR codes allow for quick accessibility and portability of several gigabytes of video data. Trainees can quickly scan the code with their mobile devices, providing JiTT to access and review education materials when needed. In the health professions learning environment that is inherently fast-paced and high-stress, QR codes have the potential to revolutionize accessibility to JiTT learning tools. 

Mayer proposed, in his multimedia learning theory, that “Learning is an active process that involves filtering, selecting, organizing, and integrating information” [11]. His theory further suggests once a learner has prior knowledge, an increasing amount of information may be integrated to produce mental constructs [11]. Utilizing QR codes, this curriculum harnesses many of Mayer’s principles of optimal multimedia learning, to include:

  • Modality. Learners absorb more from narration and graphics (incorporated into QR code links) than text and animations.
  • Multimedia. Learners appreciate more from using both words and pictures than from either alone.
  • Segmenting. The QR code allows learners to pace themselves, and review as needed, rather than be subjugated to continuous narration.
  • Temporal contiguity. Learners absorb more information when pictures and words are presented at the same time.

With the QR code’s accessibility (i.e., availability on handheld devices), learners can process the information on their own time and schedule. Likewise, as Mayer described the ability to return to the material at any time reduces the learners’ inessential processing/cognitive load and allows for knowledge integration over time.

Future Directions

Our curriculum was well-received and improved training standardization and efficiency, decreasing the burden of instruction for preceptors in addition to providing greater flexibility for learners. It has been implemented at two international military treatment facilities for new faculty and team members who participate in patient transport. As for the next steps with this training curriculum, we plan to model specific aspects unique to neonatal transport preparation, and then proceed to the recognition and management of potential in-flight emergencies.

The popularity of QR codes as an educational tool in healthcare professions education continues to rise. Due to free, user-friendly online resources for QR code generators, even tech novice educators are beginning to incorporate them into medical education. QR codes not only add value to curriculum design for educators, but they also provide a portable enduring tool for learners. Separately, this technology promotes interactive content for learners that is supported by multimedia learning theories. In an increasingly virtual learning environment for learners of all ages and stages, QR code technology offers another resource for the educator’s toolbox to enhance JiTT and blended learning in healthcare professions education.


[1] Peachey, L., McParland, T., Goldsworthy, S., and Williams, V. P stands for pivot: Pivoting face-to-face practicum to virtual simulation during the pandemic. Clinical Simulation in Nursing 57, (Aug 2021), 53–58. DOI:

[2] Bell, L. Just-In-Time Learning During a Crisis. Am J Crit Care 29, 4 (2020), 270. DOI: 10.4037/ajcc2020430.

[3] Teunissen, P., Kogan J., Ten Cate O., Gruppen L., and Lingard L. Learning in practice: A valuation of context in time-variable medical training. Acad Med 93, 3S (2018), S22–S26. DOI: 10.1097/ACM.0000000000002070.

[4] Holland, P, Cooper, B., and Hecker, R. Electronic monitoring and surveillance in the workplace: The effects on trust in management, and the moderating role of occupational type. Personnel Review 44, 1 (2015), 161­–175.

[5] Jeske, D. and Santuzzi, A. Monitoring what and how: Psychological implications of electronic performance monitoring.  New Technology, Work and Employment 30, 1 (2015), 62–78.

[6] Arshavskiy, M. Instructional Design for ELearning: Essential Guide to Creating Successful eLearning Courses, 2nd ed. 2017.

[7] Downer, T., Oprescu, F., Forbes, H., et al. Enhancing nursing and midwifery student learning through the use of QR codes. Nurs Educ Perspect 37, 4 (2016), 242–243. DOI: 10.1097/01.NEP.0000000000000040.

[8] Traser, C., Hoffman L., Seifert M., and Wilson A. Investigating the use of quick response codes in the gross anatomy laboratory. Anat Sci Educ 8, 5 (2015), 421–428. DOI: 10.1002/ase.1499.

[9] Toyohiro, K., Yuki, N., Shoko, Y, et al. Development of flash cards to teach about lesions in the jaws and maxillary sinuses. Oral Radiol 37, 2 (2021), 231–235. DOI: 10.1007/s11282-020-00435-0.

[10] Li, L., Hu, Z., Yi, Z., et al. Exploration of standardized clinical skills instruction video based on QR code management in clinical hospital teaching. Am J Transl Res 13, 12 (2021), 14067–14073.

[11] Mayer, R. Multimedia Learning, 2nd ed. Cambridge University Press, New York, 2001. 

About the Authors

Dr. Elizabeth Schulz is an associate professor of pediatrics in the division of Neonatology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Schulz is currently serving as the Director for the National Capital Consortium’s Neonatal-Perinatal Medicine fellowship program at Walter Reed National Military Medical Center. Dr. Schulz is a valued member of military medicine, currently serving as a Lieutenant Colonel in the United States Air Force and is board certified in the fields of pediatrics and neonatal-perinatal medicine. She is an invited extramural speaker at local, regional, national, and international level for her research in the preterm population and qualitative work for gender equity in academic medicine leadership. She serves multiple editorial roles for the American Academy of Pediatrics and peer-reviewed publications in nationally recognized journals contributing to the fund of knowledge and evidence-based medicine in critical neonatal care worldwide.

Dr. Katherine Ottolini is a neonatologist and assistant professor of pediatrics at Children’s National Hospital and has collaborated with the Developing Brain Institute (DBI) on research since 2018. Dr. Ottolini first became interested in neonatal nutrition while working as a pediatric resident at Walter Reed National Military Medical Center in Bethesda, Maryland. Under the mentorship of Dr. Catherine Limperopoulos as a Neonatal-Perinatal Medicine fellow at Children’s National, she utilized advanced magnetic resonance imaging (MRI) techniques to investigate the effects on early nutrition on the preterm developing brain, including the impact of macronutrients and breast milk intake. Dr. Ottolini continued to work with DBI remotely for four years while serving in the U.S. Air Force as a neonatologist based in Okinawa, Japan. Since returning to the DBI at Children’s National in September 2022, she remains focused on using advanced MRI techniques to evaluate the effects of early nutritional interventions on preterm brain development, with the aim of optimizing growth and neurodevelopmental outcomes for this vulnerable population.

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  • Tue, 08 Aug 2023
    Post by Johir

    great information