Introduction
My name is Seif Ayman, an Egyptian Clinical Pharmacist who has been working at a public hospital in Egypt since my graduation in 2013. I have always been driven by a deep commitment to supporting patients and their families by ensuring the proper use of medications and guiding them through the management of adverse drug reactions. In parallel with my pharmaceutical duties, I regularly design and implement awareness sessions for healthcare professionals within the hospital to address critical clinical and behavioral topics. Experiencing FIRSTmed-ADLX Framework, I decided to enhance the Learner eXperience and create deeper engagement in my learning journeys.
The motivation for this particular learning journey emerged from a recurring and critical issue within the hospital: hygiene. Specifically, I noticed persistent improper hand hygiene practices, which significantly affected our low-immunity patients in the Leukemia (blood cancer) department. The consequences were evident in the rise of hospital-acquired infections and prolonged patient stays. I decided to address this challenge and raise awareness through a learning journey for healthcare professionals, particularly junior Clinical Pharmacists. My learners were 12 pharmacists working in the Leukemia Clinical Pharmacy. These professionals were young and passionate, yet unaware of the impact of hygiene protocols, often misusing sanitizers and dismissing infection control measures as optional or time-wasting.
eXperience Design and Sequence of Activities
I chose the FIRSTmed-ADLX framework because it provided a clear, principle-based structure for designing an Active Deep Learner eXperience. Its focus on the learner’s engagement, reflection, and transformation aligned with the urgency and sensitivity of our topic: hand hygiene. Compared to some common training models, the FIRSTmed-ADLX framework uniquely empowers facilitators to shape both mindsets and behaviors without relying solely on instructive teaching. Consequently, I used the FIRSTmed-ADLX framework to design and facilitate a learning journey with the following learning outcomes.
Learning Outcomes:
- Attitude:
- To value hand hygiene as a vital professional responsibility.
- To appreciate the impact of hygiene practices on patient safety.
- Skills:
- To apply correct hand hygiene techniques in clinical settings.
- To distinguish between proper and improper use of sanitizers.
- Knowledge:
- To define hand hygiene guidelines as per WHO standards.
- To recognize the consequences of poor hygiene on low-immunity patients.
The learning journey was composed of two in-person, synchronous sessions, each lasting one hour. The activities were sequenced with an intentional balance between push and pull strategies, ensuring learners remained engaged while gradually building their own learning. The first session focused on awareness and engagement, while the second focused on practice and transformation.
III. Learning Activities Using RAR Modal
I designed my learning activities using the RAR model as elaborated in the examples that follow.
Activity 1: Infection Through Our Eyes
Readiness Increase:
To prepare participants for the experience, I initiated a reflective conversation inviting them to share real cases or observations of infection transmission within the leukemia department. This discussion served to activate emotional and mental readiness by directly connecting the topic to their real-life challenges. Participants expressed concern, frustration, and at times helplessness, which built a strong emotional base for learning.
Activity Facilitation:
I introduced a short yet emotionally impactful video illustrating how a simple lapse in hand hygiene can rapidly lead to infection outbreaks in hospital settings. Participants watched attentively, with visible reactions. Immediately after the video, the room shifted into a reflective dialogue.
Reviewing Actively:
Participants voiced what stood out to them, critiqued the unsafe practices shown, and related them to situations they had encountered. The facilitator invited each participant to reflect on what surprised them most during the activity. They were also asked: Why does this issue matter to your current practice? And finally, what intention or personal commitment would you like to take forward into your professional routine? These reflections helped internalize the emotional impact of the activity and translated it into awareness of needed behavior change.
Activity 2: Our Hands, Our Steps
Readiness Increase:
This activity began by deepening the awareness built in the previous one. To increase readiness, I distributed printed WHO guidelines for hand hygiene and gave participants time to review them silently. This was followed by a brief challenge: “Compare what you read to what you do every day—what might you be missing?” The question sparked curiosity and honest self-questioning within the room. At this stage, I introduced the question, invited the learners to form small groups and engage in a comparison between their current practices and the global standard. I made sure the instructions I provided were clear but didn’t pull answers.
Activity Facilitation:
Each group discussed misconceptions or overlooked details. This transitioned into a practical peer-learning activity, where pharmacists took turns demonstrating proper hand hygiene techniques. Their colleagues offered positive and constructive feedback, creating a safe, supportive environment for skill enhancement.
Reviewing Actively:
The participants revisited the reflective prompts introduced earlier, but now with a behavioral focus. They were asked to identify one insight or practice that changed their perspective, describe why it matters in their context, and declare a concrete commitment they would implement starting the next day. This process supported a shift from theory to intention to action.
FIRST Domains in Action
F – Focusing:
I addressed individual learner needs by using names, asking about their previous knowledge, and encouraging them to reflect on their real-life experiences. Their contributions were acknowledged and integrated into the session flow, reinforcing their sense of ownership.
I – Interacting:
The learning atmosphere was designed to be socially supportive and emotionally safe. Learners interacted through peer discussions, video analysis, and joint reflections. They felt heard and respected, which built trust and group cohesion.
R – Reviewing:
The RAR model was embedded throughout the program. From readiness-building questions and video engagement to facilitated application and reflective debriefs, the process was intentional and layered. Reviewing actively was not a separate event but a continuous thread.
S – Sequencing:
The sessions were carefully structured to follow a logical flow—from awareness to reflection to application. Push strategies (video, guidelines) were paired with pull strategies (peer feedback, questions), and energy levels were managed through variation in formats and pacing.
T – Transforming:
Posters with hand hygiene instructions were distributed and later observed in various hospital departments. Participants reported back that they were reminding each other to adhere to the guidelines, especially during intravenous drug preparation. This change reflected a tangible shift from learning to performance.
Conclusion
FIRSTmed-ADLX Framework led to a noticeable shift in mindset among the pharmacists. They no longer saw hand hygiene as a burden but embraced it as a professional responsibility. The learning journey’s ripple effect reached other hospital departments, and I began receiving requests to repeat it. The visible presence of hygiene posters and the mutual reminders between pharmacists were powerful indicators of a transformative impact.
As a facilitator, this experience deepened my understanding of how FIRSTmed-ADLX can create Active Deep Learner eXperiences that lead to deep and transformative impact on the learners. I moved beyond simply transferring knowledge to enabling transformation. I learned that facilitation is not about control but about creating the right conditions for learning. I now aim to design every session to be an Active Deep Learner eXperience.