There is a phrase that has been quietly reshaping workplace learning and development over the past several years, and it is now arriving with some force at the door of language education: learning in the flow of work.
Coined by HR analyst Josh Bersin in 2018, the concept integrates learning into the everyday tasks and workflows of employees, contrasting with traditional approaches that involve separate, dedicated learning sessions or courses (Growth Engineering, 2025).¹ For medical English educators and heads of learning and development at healthcare institutions, it raises a productive question: what would it look like if language development stopped being something that happened in a classroom — and started happening in the ward, the corridor, the handover room, and the staffroom?
The starting point has to be an honest reckoning with the conditions under which healthcare professionals actually work. With 12-hour shifts, workforce shortages, and mounting administrative burdens, finding time to study feels almost impossible for many clinicians (Nurses Educator, 2026).² This is perhaps the defining structural challenge facing any language programme targeting working healthcare professionals. Research has found that 25% of employees say they lack the time they need to complete training, and ‘learning in the flow of work’ consistently ranks among the top challenges for learning and development departments (eLearning Industry, 2024).³
The healthcare sector has begun to respond to this with microlearning – short, focused modules designed to fit around shift patterns rather than demand time away from them. Quick modules help healthcare professionals learn during breaks, improve retention, support continuous learning, and immediately apply new skills in their work (iSpring, 2025).⁴
Some of the early evidence is striking: the Mayo Clinic has integrated bite-sized clinical training modules into its nursing orientation and ongoing professional development programmes, reporting improved competency assessment scores and reduced time-to-competency for new hires. The Veterans Health Administration uses microlearning modules embedded within its electronic health record system to provide just-in-time training on updated protocols directly at the point of care (Nurses Educator, 2026).²
While these examples are not language programmes, they demonstrate something important: that the infrastructure for delivering learning in the flow of clinical work already exists and is already delivering results. The question for medical English teachers is whether language development can be delivered in the same way.
The need is substantial. Healthcare systems across the English-speaking world are increasingly reliant on internationally educated professionals, and language demands extend well beyond a pre-employment proficiency test. In the UK, research examining the linguistic challenges facing international medical graduates integrating into the NHS found that even though many were educated in English, they frequently struggled with local dialects, colloquialisms, and the unwritten conventions of clinical communication (Al-Kamali, Zangana, & Al-Rawas, 2024).⁵
The challenge is not just vocabulary or grammar: it is the register of a handover note, the phrasing of a difficult conversation with a patient’s family, the shorthand of a multidisciplinary team meeting, the precise language of a clinical incident report. Analysis of online language training trends in 2026 frames the question well: the real issue is no longer ‘how do we help healthcare professionals study a language?’ but ‘how do we help them communicate better in the middle of actual work?’ – a far more practical starting point that reflects how professionals operate today: under time pressure, in high-stakes situations, and often without access to a formal learning environment (Myngle, 2026).⁶
The learning science here is encouraging. Spaced repetition – the practice of reviewing vocabulary at increasing intervals – is among the most evidenced techniques in language acquisition research, with studies consistently finding that spacing practice sessions over time produces stronger long-term memory than massed practice. Cognitive explanations include repeated retrieval, reconsolidation of memory traces, and increased attentional engagement (Cepeda et al., as reviewed in multiple 2024–2025 meta-analyses).⁷ Critically, spaced repetition is well suited to the fragmented time available to clinical workers: a two-minute vocabulary review on a smartphone between patients is not a compromise version of learning – it may, the evidence suggests, be a more effective one.
Platforms such as Anki, Quizlet, and Memrise already operationalise this principle, incorporating spaced repetition algorithms that adapt review schedules based on user performance, enabling learners to focus on weak areas and reinforce retention in a personalised, data-driven manner (Alisoy, as cited in Porta Sapientia, 2025).⁸ For medical English, the application is direct: clinical terminology sets, communication phrase banks for breaking bad news, condition-specific vocabulary for specialties can all be delivered in two-to-three-minute bursts, scheduled around shift patterns, and reviewed on a ward device or personal phone.
AI is now accelerating the possibilities further. Analysis of learning and development trends for 2026 finds that AI agents can deliver microlearning, personalised recommendations, and coaching directly within the tools and systems employees already use, with real-time feedback ensuring skills are applied correctly and helping employees learn faster and retain knowledge more effectively (Cornerstone OnDemand, 2026).⁹ In a healthcare context, this could mean a system that notices a clinician is preparing to write a discharge summary and surfaces a brief language prompt about the conventions of that genre, or one that flags relevant communication phrases ahead of a patient type the clinician has not encountered in English before.
For medical English teachers, the flow-of-work model is not a threat to the classroom — it is a complement to it. The research distinction between microlearning and macrolearning is useful here: microlearning content is short and focused enough to meet an immediate need – a video, article, or audio clip that can be easily indexed and found – while macrolearning develops new skills over time (Bersin, 2018).¹⁰ Both are necessary. A structured course develops the deep competence; flow-of-work tools sustain and reinforce it between sessions, in the moments when clinical language is actually being used. They work together.
For heads of learning and development at hospitals and healthcare employers, the practical implication is to ask a simple but transformative question when commissioning or reviewing language programmes: not just where will training happen, but when – and whether those moments are as close as possible to the real communication demands of the working day.
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