Delirium, a serious medical condition, is often under-recognised and sub-optimally managed by hospital staff.^1,2 It accelerates cognitive decline and is associated with increased mortality and institutionalisation.^2–5 Educational interventions improve delirium recognition, underscoring their pivotal role in enhancing care standards.^6,7 The International delirium curriculum prioritises delirium in medical education and recommends integrating the curriculum requirements in medical degree programmes.⁶

The medical education landscape is evolving with a paradigm shift towards harnessing novel educational strategies. A scoping review on microlearning, the acquisition of knowledge or skills in small units, has shown a positive effect on knowledge and confidence among health professional students.⁸ The review has implications for educational researchers, faculty, and academic administrators to apply microlearning in practice to advance course content in didactic and clinical settings.⁸

Microlearning applications include infographics, podcasts, videos, and electronic learning modules, which can leverage digital technology for an engaging learning experience.^9,10 Infographics are visual representations of information that help communicate complex concepts and information efficiently and effectively.¹¹ As an emerging pedagogy in medical education, infographics enable students and clinicians to engage in “just-in-time” learning.¹⁰ We hypothesised that implementing a delirium infographic with microlearning as a pedagogy would improve delirium learning among medical students within a Geriatric Psychiatry Liaison Service.

Our study evaluates an educational intervention using a novel infographic to improve delirium learning among medical students within the Geriatric Psychiatry Liaison Service at Changi General Hospital, a public hospital in Singapore.

A total of 28 medical student learners participated in 6 PDSA cycles with a 100% response rate to the anonymised survey.

The needs assessment survey results in the first PDSA cycle, analysed using descriptive statistics, are presented in the supplementary material. The data is presented in absolute counts due to the small number of study participants.

Refer to Supplementary material on needs assessment survey results (Supplementary Figure 1-3).

The results of thematic analysis for all PDSA cycles (Table 1-3).

The study analyst was a single coder who conducted the coding process, systematically identifying and categorising key themes and sub-themes within the reflections provided by participants. The analysis read through the responses multiple times to immerse in the data and generated initial codes by highlighting significant phrases and ideas in the responses.⁴³ Codes were grouped into broader themes that reflected shared patterns across participant responses. The thematic structure was refined iteratively to ensure coherence and clarity. The analyst reviewed themes to confirm that they accurately represented the data and provided meaningful insights into participants’ reflections on delirium learning. The themes, with some exemplary quotes, are listed below.

In the PDSA 1^st cycle, all 7 participants provided learner reflections. The data analysis identified 4 themes:

Team approach, knowledge enhancement, learning opportunities and recognition of delirium.

“A great learning opportunity to have a first-hand experience and to partake in different parts of a comprehensive geriatric psychiatry assessment.”

In the PDSA 2^nd cycle, the qualitative data of all 9 participants were extracted, generating 3 themes: visual appeal, infographic comprehensiveness and conciseness, which highlighted the infographic’s usefulness in delirium learning. The medical students expressed the infographic as useful and visually appealing.

“It’s good to have a graphical review, not cluttered.”

“A good overview for delirium: its diagnostic criteria, clinical features, management, and what we can do in other settings outside of psychiatry.”

“Useful one-page summary and overview of the important aspects of delirium knowledge.”

In the PDSA 3rd cycle, extracting all 4 participants’ qualitative data generated four themes: understanding diagnostic criteria, pre- and post-approach, the importance of education, and case-based learning. All 4 themes expressed the usefulness of the infographic in knowledge enhancement and understanding delirium and recommended that the infographic be disseminated to all healthcare professionals.

“Delirium is commonly seen in hospital settings. Hence, I find it particularly useful and strongly suggest this to be promoted to all healthcare professionals.”

PDSA 4^th cycle had 2 participants, and data extraction generated three themes: visual presentation, diagnostic criteria, and case-based discussion.

“Clearly shows the criteria, causes, and management for delirium.”

PDSA 5^th cycle had 3 participants, and analysis of learner reflections generated three themes: efficacy of screening tools, preparation for clinical practice and holistic approach.

“Succinctly presented, which allows easy memory retrieval.”

PDSA 6^th cycle had 3 participants, with 5 themes generated from analysis of learner reflections: the screening tool’s effectiveness, theoretical foundation, bedside teaching, challenges in practice, and sequential learning journey.

“Helpful in terms of the 4AT screening tool.”

The final version of the delirium infographic ( Figure 2 ).

This educational improvement study on 28 medical students supports the implementation of an infographic as an educational intervention to improve delirium learning in a Geriatric Psychiatry Liaison Service. The learner reflections in this study demonstrate the usefulness of qualitative methodology in quality improvement studies.⁴⁴

The thematic analysis results indicated knowledge enhancement in all 6 PDSA cycles; the other recurring themes were the infographic’s comprehensiveness and visually appealing aesthetics. A mixed methods systematic review on digital education in delirium for healthcare professional students has demonstrated that digital programmes should be visually attractive, with opportunities for clinical practice and timely and appropriate feedback.⁴⁵ Consistent with the systematic review’s key findings and practice implications, we designed a visually appealing infographic in our study.⁴⁵

Microlearning was the pedagogy employed in our study, designed for learners to use the information in the infographic in “just-in-time” learning.^10,46 Evidence indicates that microlearning reduces cognitive overload by breaking down complex information into micro units.¹⁰ Furthermore, research in medical education has demonstrated that people learn better with cues and when words and pictures are presented simultaneously.⁴⁷ While there is emerging research data on podcasts and other technology-enhanced education in delirium,⁴⁵ robust data on microlearning in delirium education is lacking. We, therefore, propose the need for research advances on microlearning applications in delirium education with robust qualitative and quantitative study designs.

The study’s strengths include using a novel microlearning pedagogy and a comprehensive delirium infographic and the involvement of medical learners in study design, infographic content, and aesthetics, emphasising a learner-centred approach. The study’s qualitative approach captured the rich data on medical student reflections on delirium learning, which quantitative data alone may fail to capture.

We acknowledge the study’s limitation, reporting findings from a one-off educational intervention in a convenience sample of medical students. The study has selection bias, a potential limitation we recognise. The study is a quality improvement initiative, and having a large sample and collecting comprehensive demographic data with a control group of learners was not feasible, which we acknowledge as study limitations. The thematic analysis was undertaken by a single coder (study analyst), and we addressed this limitation using a systematic approach to thematic analysis. We did not capture patient-related outcomes such as length of stay, mortality and institutionalisation, which are essential but out of the study’s scope as an educational Quality Improvement study. Notwithstanding the limitations, we believe the results are meaningful, and the qualitative data captured real-time learner feedback.

We have now integrated the infographic into the Duke-NUS medical school electronic learning portal for psychiatry clerkship, which all medical students can access, embedding digital education in delirium. Plans are underway to disseminate the infographic to all residents and junior doctors in training at the study site as part of hospital orientation.

Through this publication, we aspire to promote the infographic as a digital intervention that students and clinicians can access at any time for “just-in-time” learning.

Our single-site educational improvement study, conducted in a real-world clinical setting, supports implementing a delirium infographic as an educational intervention, with microlearning as the pedagogy to augment delirium learning in a Geriatric Psychiatry Liaison Service in a public hospital in Singapore. We propose future research directions on microlearning as a pedagogy in delirium education to augment learner acquisition of knowledge and translation into improved patient care.