Knowledge is Best When it is Dosed Daily

I’m making a pitch for reciprocal education.

EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesday. The following is an edited transcript of her reporting.

To set the stage, I am currently engaged in a really fun, intellectually challenging ongoing project. I compose multiple-choice questions on a really slick platform called DosedDaily for a payer organization to improve and standardize their review processes. The participants get a single multiple-choice question daily, and on Fridays, they get a longer, case-based question in three parts.

Truth be told, someday I really want to flip it around and educate emergency physicians and hospitalists to optimize their status-determining skills. I think this vehicle would be superlative for teaching clinical documentation improvement (CDI) to providers, too. But I digress.

To design an effective multiple-choice question, one has to research the topic to understand what the current evidence-based standard of practice is. Then, you need to ascertain what the knowledge gap of your participant is, and determine what they need to know to change their behavior and achieve the intended outcome. You have to figure out what factoids you want them to learn from this question, and they should learn as much from the wrong choices as the right ones.

I spend a lot of time pondering how I can make the participant have to think. I don’t want the correct answer to be so obvious that anyone could guess it. For instance, I wouldn’t just say “GI bleed” with my outside voice. I offer “black, tarry stools with epigastric pain” instead. I craft patient scenarios that set the stage for asking thoughtful questions, and then I may vary some of the features to pose the same question with different clinical indicators.

The explanations as to why A is the correct choice and B through D were wrong is where the participants hopefully expand their knowledge base. You have to make the explanations clear, concise, and edifying. This platform is meant to offer short, quick, interesting aliquots of information that move the needle and improve organizational metrics.

The really fun part is that I learn a tremendous amount in the process. I was researching anemia recently, and discovered that tonic water had been the cause of my father’s chronic thrombocytopenia. Did you know that pagophagia is the excessive eating of ice, seen in pica from iron deficiency anemia? It goes away as soon as iron therapy is initiated, often before there is any observable hematologic response. How cool is that?!

So, here’s my pitch. I want to challenge you to create a question for your colleagues about whatever it is that you do. Whether you are in compliance or coding or CDI or medical necessity, find some interesting point that you think your work friends could benefit from learning. Google a question you have, and read an article. That is how you will find related information to serve as the other choices.

Don’t make it a true-or-false binary question. Find three other points that complement the first fact. It may be three false choices and one true one, or vice versa. Then type out the explanation as to why the right answer is right and the others are wrong.

You could even ask your buddies to make their own questions, too. You could teach each other new information, or reinforce best practices. You could dose your questions daily or weekly. If we stop learning, we stagnate. This will be a fun way for you and your colleagues to grow your knowledge base.

If you enjoy this exercise, feel free to email your questions to us at I’d love to learn from you. Who knows? Maybe I will share your question in a future TalkBack or listener survey.

Programming Note: Listen to Dr. Remer’s live reporting every Tuesday during Talk Ten Tuesday, 10-10:30 a.m. EST.


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