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proposal
Vicarious learning in the
time of coronavirus
Christopher G. Myers
abstract *
Health professionals confronting the COVID-19 pandemic need to
learn vicariously—that is, learn the lessons of others’ experiences—if
they are to adopt and spread best practices for treatment, avoid costly
repetition of prior mistakes, and not waste time “reinventing the wheel.”
Digital communication tools and social media could be leveraged to
facilitate this vicarious learning in much the same way that they are being
used to support other types of interpersonal interactions amid social
distancing. Yet these tools are often not used to their full potential for
learning and knowledge sharing among health professionals fighting
COVID-19. Drawing on organizational and behavioral science research
into how individuals and organizations learn from others’ experiences,
I recommend guidelines, policies, and practices that can increase both
the use and the effectiveness of technological tools and social media to
enhance vicarious learning among the health professionals at the front
lines of pandemic care.
Myers, C. G. (2020). Vicarious learning in the time of coronavirus. Behavioral Science
& Policy 6(2), 153–161. Retrieved from https://behavioralpolicy.org/journal_issue/
covid-19/
a publication of the behavioral science & policy association 153I
n the face of a pandemic, such as the current Yet as the global spread of the disease continues,
COVID-19 crisis, health professionals around there is clearly room for improvement in learning
the world struggle to acquire the informa- from others’ experiences with COVID-19. Diffu-
tion and skills needed to meet the challenge of sion of knowledge about effective treatments
providing high-quality care. These outbreaks and policies for combating the disease remains
disrupt existing routines and resources, testing slow, with different countries unfortunately
the abilities of individuals and organizations “reinventing the wheel” in their approach to the
to learn and be resilient as circumstances disease rather than learning from the errors and
change and difficulties escalate. In many ways, successes of earlier efforts.13 The reasons for
responding successfully to a pandemic depends this suboptimal vicarious learning are varied, of
on effective vicarious learning—learning that course, but they include a tendency to rely on
occurs through being exposed to and making formal, static mechanisms for sharing experi-
sense of others’ experiences1—and on applying ences with the disease; inadequate opportunities
the lessons of those experiences to the situa- for health care providers to directly interact with
tion at hand. As the disease spreads, learning peers who are treating the disease in other coun-
from others’ earlier successes and failures in tries; and a lack of leadership in organizing and
addressing it can help speed the deployment of clearing away obstacles to engaging in those
effective treatment practices while also helping interactions. In the text that follows, I address
to minimize the amount of time spent repeating processes identified in organizational research
prior mistakes. that can facilitate more effective vicarious
learning and suggest actions that leaders can
This need to learn vicariously from others’ take to increase such learning by health profes-
pandemic experience to increase the effec- sionals on the front lines of the COVID-19 crisis.
tiveness of one’s own efforts is consistent with
findings of a significant body of organizational
and behavioral research. This research has Processes That Facilitate
explored the process of vicarious learning at Vicarious Learning
a variety of organizational levels—among, for Moving Beyond Formal, One-Way
example, individuals, teams, units, and firms— Knowledge Dissemination
and has documented how vicarious learning Part of the challenge of engaging in vicarious
can improve performance in a wide range of learning about COVID-19 is that much of the
industry settings, from information technology knowledge about others’ experiences with
and banking to pharmaceutical research and the disease comes through high-level, static
aerospace exploration. 2–7 documentation rather than active discussion
or interaction. Stories of others’ experiences
Like companies in these other industries, health treating COVID-19 are often shared through
care organizations devote significant effort to outlets such as news articles or governmental
enabling vicarious learning—for instance, by reports that attempt to capture a dynamic
forming quality improvement collaboratives to experience and summarize it in a medium or
share knowledge and learn from others’ innova- document meant for independent consumption.
tions.8 Efforts to foster such learning in the face During this summarization process, much of the
of COVID-19 have built on these existing prac- nuance or contextualized understanding of the
tices, providing valuable ways to incorporate experience can be lost, either unintentionally
lessons from others’ experiences with treating or as a by-product of fitting the experience to a
the disease. For instance, efforts to document particular perspective, leaving readers less able
and disseminate information on early patient to draw useful insights for applying lessons to
testing and treatment in Asia provided an oppor- their own situations.
tunity for health professionals in other countries
to learn vicariously from these early experiences Recent organizational research has pointed out
with COVID-19 and thereby enhance their own the inadequacy of relying solely on these arm’s
treatment efforts.9–12 length, one-way forms of vicarious learning,
154 behavioral science & policy | volume 6 issue 2 2020particularly in complex, dynamic environments stories of other clinicians’ patient care experi-
like those in which health professionals work.1 ences and, in particular, from stories of these
Learning from others in these environments colleagues’ exceptionally successful cases.18
often requires more significant interaction and
back-and-forth discussion between the people
who are conveying their experiences and the Ways That Technology
recipients who are learning from them—a give- Can Support Vicarious
and-take that allows for questioning, analyzing, Learning About COVID-19
and refining one’s understanding of the These findings suggest that frontline health
experiences in ways that enable better contex- professionals can benefit greatly from meeting
tualization and adaptation.1,14 to share and discuss stories with one another
about their successes and failures in treating
Engaging in Peer-to-Peer Vicarious COVID-19. Unfortunately, the global dispersion
Learning Interactions of this pandemic and those treating it, alongside
Beyond being one-way, static communica- the mandate to practice greater social distancing
tions, much of the documentation mentioned to curb the disease’s spread, make it difficult
above targets a broad population of readers, to enact policies to encourage interpersonal
which limits its value for helping frontline health learning interactions. Yet more technolog-
professionals learn from their peers’ experi- ical tools exist today to address these barriers
ences. The questions and knowledge needs of than during any prior pandemic. And although
those engaged in on-the-ground patient care technology for treating COVID-19 patients has
often differ from those of the general public advanced considerably—for example, telemed-
or government officials. Health professionals icine allows health care workers to conduct
are likely to learn more if they can communi- some types of patient screening and treatment
cate directly with their peers (rather than having while maintaining social distancing19—these
these communications mediated through same tools have yet to be fully adopted to
reports or media documents). Peer-to-peer enable vicarious learning among the health
interactions allow health professionals to share professionals providing the treatment.
more nuanced, tacit knowledge, because they
can rely on common terminology and norms Technological tools such as videoconferencing
that make it easier to draw lessons from one and social media allow for greater connec-
another’s stories and experiences. tion and collaboration across the globe and
have been increasingly playing a role in health
Organizational and behavioral research in health professionals’ interactions and learning in
settings has repeatedly demonstrated the value recent years. 20–22 A variety of different social
of peer-to-peer vicarious learning as a way for media groups on platforms such as Face-
health professionals to gain knowledge and book and Twitter have emerged as community
enhance patient care. For example, surgeons forums for health professionals, often focusing
practicing in a group setting or engaging in on a particular specialty or area of interest. For
comparatively more peer interactions have instance, one closed-membership Facebook
been shown to perform better on recertification group of robotic surgeons from around the
exams,15 consistent with evidence that formal world (some of whom may be the only one
continuing medical education (CME) efforts are in their geographical area performing robotic
more effective in changing behavior when they procedures) has allowed members to connect
involve interaction or peer discussion. 16 Other with one another and post questions, photos,
research has shown that cardiac surgeons’ post- or surgical videos to share their techniques or
operative mortality rates are influenced not only seek others’ advice. 23,24 Groups such as these
by the surgeons’ own past successes and fail- provide opportunities for learning and rapid
ures but also by the experiences of their peers.17 dissemination of ideas and techniques and
Likewise, emergency department clinicians can amplify the benefits of vicarious learning,
have been shown to be motivated to learn from allowing for knowledge sharing by experts who
a publication of the behavioral science & policy association 155may be geographically remote while also multi- conduits for vicarious learning already being
plying the number of potential learners who can used by those fighting COVID-19. Existing social
benefit from the information that is discussed. media groups for health professionals represent
a valuable resource for sharing knowledge—
Some efforts are already underway to make use many have memberships numbering in the tens
of these technology-mediated, virtual vicar- of thousands,25 often with a core of highly active
ious learning interactions in the fight against users who engage meaningfully with posted
COVID-19. News stories have documented questions or information. 23 Although concerns
the use of social media to rapidly spread clin- about misinformation on these platforms are
ical information and combat misinformation on not unfounded, 25,28 developing policies and
COVID-19 and increase interaction and collab- providing resources to allow individuals to
oration among physicians. 25 Other reports have better engage with these existing platforms (as
noted the use of teleconferencing by health opposed to avoiding or ignoring them) can help
professionals in Italy and the United States to address the worries about misinformation.
to learn from their counterparts treating the
disease in China. 26,27 Yet these efforts are often For instance, hospital leaders could identify
too sporadic or isolated to have a systematic individuals in their organizations who already
impact on the pandemic. And there are multiple engage frequently with these kinds of groups
obstacles to their use, not least being that and tap them to form a social-learning initia-
many health professionals are uncomfortable tive or committee. This committee could then
with or lack knowledge of how to apply these serve as the designated outlet for sharing accu-
technologies for peer learning. Indeed, some rate, real-time data from the hospital (such
health care professionals have been hesitant as up-to-date patient counts, documented
to use these tools owing to concerns about outcomes, revised protocols, or other approved
privacy (both their own and their patients’), as information) on these social media platforms;
well as about their reputation, their potential the committee could also be tasked with inter-
malpractice liability, or simply the burden of preting and incorporating the knowledge that
trying to participate in or manage a worldwide people from other institutions post to these
community forum. 24,28 As a result, efforts to groups. Creating this central contact point for
engage these frontline health professionals in knowledge flowing out of and into the hospital
technology-enabled vicarious learning still face via social media would enable the information
significant challenges that limit its widespread being shared to be better filtered for quality,
adoption in combating COVID-19. allow for more systematic dissemination among
care teams within the hospital, and provide
a critical knowledge resource to COVID-19
Policy Actions to Advance decisionmakers.
Vicarious Learning in the
Time of Coronavirus At the same time, leaders and policymakers
These challenges are nontrivial but not insur- at the national level—for instance, leaders of
mountable. As detailed in Table 1, leaders and professional associations or advocacy groups—
policymakers—both within particular health could work in the short term to remove some
institutions and outside of them (nationally and of the barriers to engaging in virtual vicarious
internationally)—can take a variety of actions learning among health professionals. One key
to enhance and extend technology-mediated action would be advocating for legal protec-
vicarious learning among health professionals. tions for technology-mediated peer learning,
including working to incorporate this kind of
Increase the Use & Value of Existing learning into existing frameworks that protect
Vicarious Learning Technologies other peer-learning and quality-improvement
In the short term, hospital and practice leaders tools (such as informal conversations or
can more extensively engage with technological morbidity and mortality conference discussions)
156 behavioral science & policy | volume 6 issue 2 2020Table 1. Strategies & actions for enhancing virtual
vicarious learning among health professionals
Strategic goal
(time frame) Action steps for leaders and policymakers
Organizational and institutional leaders can:
• identify employees who are active members of online health professional groups
or social media platforms and provide resources and support (such as time and
recognition) for bringing in outside knowledge via these platforms to improve the
organization’s practices.
• set up a working group or committee to organize knowledge shared and received
via these online learning communities and provide them with more frequent access
to pertinent data to share with others for learning and feedback (such as hospital-
level case data, equipment status, or clinical-protocol revisions, in consultation
Increasing the with hospital legal personnel as needed to ensure compliance with regulations and
use and value privacy guidelines).
of existing • cultivate within-organization standards and norms for learning and sharing
vicarious learning knowledge with others (not only outside the organization but also across different
technologies (in internal care sites or units) and for incorporating this knowledge into decisionmaking.
the short term)
Professional associations and national policymakers can:
• use existing platforms and clout to advocate for appropriate legal protections for
online vicarious-learning activities among health professionals, conferring these
virtual tools with protections similar to in-person peer-learning activities (such as
morbidity and mortality conferences and quality-improvement efforts).
• develop a database of reputable health professional social media groups (including
associations’ own forums or discussion groups) and encourage engagement in online
vicarious learning among association members or other constituents to help further
reduce reputational barriers to engaging in peer-learning interactions.
Organizational and institutional leaders can:
• strengthen partnerships with neighboring organizations (such as regional associations
of hospitals or partner members of health system networks) by creating shared
practices and expectations for how vicarious learning (both in-person and virtual) will
be carried out to help connect health professionals at each organization.
• expand formal organizational connections (for example, institutional partnerships,
professional-exchange programs, or information-sharing collaboratives) with a broad
set of organizations around the globe to establish a network of learning relationships
that can be drawn on in a future crisis or pandemic.
Creating new
vicarious learning Professional associations and national policymakers can:
opportunities • engage health technology companies to establish secure, privacy-compliant
and technology platforms for online discussion and interaction to provide association members and
platforms (in the other constituents with a reliable tool for engaging in peer-to-peer vicarious learning.
long term) • encourage the integration and cross-compatibility of online peer-learning platforms
with other systems and technologies, such as electronic medical record software,
to enable or potentially automate knowledge sharing (such as using analysis of
de-identified, privacy-compliant data to connect health professionals experiencing
similar patient challenges).
• incorporate in-person or online vicarious learning or both into standard expectations
and practices within professional communities (such as by including vicarious
learning in continuing education expectations and credentialing processes) to embed
these practices into professionals’ usual workflow before they are urgently needed in
a crisis or pandemic.
from undue legal challenges. 24 National associ- Create New Vicarious Learning
ations could also take advantage of their existing Opportunities & Technology Platforms
networks and social platforms to increase In the longer term, leaders and policymakers
access to virtual vicarious learning, either by across all levels of the health industry can work
providing their own forums for peer interac- to build a more robust infrastructure for peer-
tion (such as a member discussion hub) or by to-peer vicarious learning, helping to routinize
curating and promoting lists of reputable social this method of sharing knowledge before the
media groups for health professionals. next global pandemic or crisis arises. At the
a publication of the behavioral science & policy association 157local level, hospital leaders can work to build patient–physician engagement and telemed-
stronger relationships with other organizations icine,19 development of a similar platform for
to better position their staffs to engage in vicar- virtual knowledge sharing, advice seeking, and
ious learning with these partners in the future, interactive peer-to-peer discussion among
including by setting up in-person knowledge- health professionals does not seem out of
sharing conferences or personnel rotation reach. Professional associations can take
programs as well as virtual-learning oppor- charge of these platforms, providing them as
tunities. Having these relationships already tools for their members to connect with and
established can be useful for rapid vicarious learn from one another and incorporating the
learning in times of crisis, as vicarious learning platforms into broader learning practices. For
is often easier when parties share a preexisting instance, although CME programs are increas-
commonality or relationship. Indeed, organi- ingly making use of technology platforms, they
zational research has shown that having more are often used to replicate formal, noninterac-
deeply embedded ties or a common identity tive continuing education modalities such as
with a partner can help reduce the perceived slides, readings, or recorded presentations, 31
risks of sharing private information and facilitate despite evidence of the value of interactivity
knowledge transfer. 29,30 for both in-person and online CME. 16,32 Profes-
sional associations and accrediting bodies can
This benefit of closer ties can help explain also expand the use of new technological tools
why the vicarious learning that has occurred to include more informal peer-to-peer learning
so far in the fight against COVID-19 has often interactions—and not only by providing the
been driven by preexisting social relationships. platforms for doing so. They can also find
For instance, infectious disease specialists at ways to incorporate these interactions into
Johns Hopkins University held a videoconfer- professional learning requirements (such as
ence to learn from Chinese physicians treating by including in-person or online peer learning
COVID-19, an opportunity realized primarily interactions in annual CME standards) and can
because an office mate of one of the special- advocate for integration of these platforms
ists personally contacted several former medical with other frequently used health technologies
school classmates in China. 26 Yet even among (such as electronic medical record systems).
these personal contacts, some were hesitant to Doing so would help to further embed vicar-
share their specific experience in the absence ious learning into the habits and routines of
of national treatment guidelines in China (out health professionals, allowing these interac-
of worry over potentially spreading incorrect tions to become a common learning practice,
information), with one hospital’s leaders ulti- both for regular times and in a pandemic.
mately agreeing to participate at least partially
because its physicians had already successfully Enhanced coordination and support for using
held similar meetings with hospitals in Europe social media as a learning tool; appropriate
(see note A). This experience points to the value legal protections for virtual knowledge sharing;
of hospitals forging more global partnerships increased partnerships and learning relation-
and ties, so these kinds of exchanges become ships across organizations; and access to secure,
more routine (rather than tied to idiosyncratic privacy-compliant platforms for peer-to-peer
personal connections) and thus can serve as learning are challenging goals for health leaders
reliable tools for future vicarious learning. and policymakers to achieve, but they are
attainable. Adopting these interventions would
Finally, leaders and policymakers can go a long way toward achieving more effective
encourage health technology companies vicarious learning by the worldwide commu-
to develop more secure and easy-to-use nity of health professionals, thereby enabling
peer-learning and knowledge-sharing plat- more rapid dissemination of best practices and
forms for health professionals. Given that lessons learned in the fight against COVID-19
existing technologies already allow for virtual and future epidemics.
158 behavioral science & policy | volume 6 issue 2 2020author affiliation Endnote
I thank Annie Antar and Weiwei Dai, as well as Shmuel
Myers: Johns Hopkins University. Author’s Shoham, all at Johns Hopkins University, for their
e-mail: cmyers@jhu.edu. efforts to organize and publicize the virtual learning
opportunity that occurred between physicians at
Johns Hopkins University and physicians from the
Zhejiang University School of Medicine in China and
for providing me with details about the meeting’s
origin and structure.
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