By Paul Sullivan, Associate Director of Business Development, Noble


More than 50 biologic medications and vaccines are currently marketed and delivered in prefilled syringes1. Each year, more than 3.5 billion prefilled syringes are manufactured and used by patients and healthcare providers throughout the globe to treat a wide range of conditions. In addition, PhRMA estimates that more than 907 biologic medications and vaccines are currently in clinical development (Phase I-III), many of which will utilize prefilled syringes as the preferred delivery systems and primary containers2. It is evident that treatment via biologic medication administered through prefilled syringes is the way of the future. As these products continue to supplement and enter new therapeutic areas, more and more patients will need to embark on a learning curve that is possibly unlike any they’ve experienced prior.


A Whole New Learning Curve

This learning curve typically begins when a patient receives a diagnosis involving auto-injection therapy from a healthcare provider. Once the diagnosis is delivered, the therapy onboarding period (i.e. the first 30, 60, 90 days of treatment) will begin and the learning curve moves into motion. At the start of this journey, many patients will experience a range of challenges that affect not only the efficacy and span of their learning process, but also the patients’ therapy adherence and outcome. These challenges, which include cognitive, physical and emotional factors, can lead to errors, injuries, and adverse events. In fact, a recent study conducted by the University of Texas found that only 16 percent of patients use auto injectors properly, and that more than 50 percent skipped three or four steps during each injection.

While all cognitive, physical and emotional factors contribute to adherence, the emotional elements of confidence and anxiety were found to have a very high influence on patients’ attitudes toward medication and drug delivery devices. It is these two emotional factors that are indicative of treatment outcome, as they may lead to avoidance behaviors that prevent patients from realizing the full therapeutic benefits of the treatment. As an example, research suggests that 45 percent of patients skip or avoid injections during onboarding due to anxiety or fear3. The key to combating development of these detrimental emotions is to provide training prior to the first injection, so that the patient’s training is not by trial and error with the actual drug delivery device, but via a simulated training environment. Thus, the patient builds confidence and reduces anxiety, thereby minimizing risk of engaging in avoidance behaviors.


Factors that Affect the Learning Curve

To help facilitate patients’ learning curve, several auto-injector training devices that incorporate understanding of the cognitive, physical and emotional human factors have been developed and are currently on the market. These device trainers mimic the medical device and utilize multisensory technology to improve message recall, giving patients a practice tool to master technique and ensure proper use without including a needle or the drug. The multisensory technology is comprised of audio, visual and tactile feedback to optimize learning. Recent studies have found that stimulating multiple areas of the brain during training increases the recall and retention of educational messages. Thus, multisensory training devices may be the key to achieving an increased level of understanding and quite possibly maximized and shortened learning curves.

This conclusion was demonstrated in a recent study conducted by Noble®, the leader in the design and manufacturing of multisensory educational tools and training technology for drug delivery devices. The study uncovered the impact of device trainers on patient experience by comparing the number of errors patients made while practicing injection treatments with four different combinations of training tools. Patients were divided into four groups: Group 1 received Instructions for Use (IFU) only; Group 2 received IFU and a Mechanical Trainer that provides tactile and visual feedback only; Group 3 received IFU and a Talking Trainer that provides tactile, visual and audio feedback; and Group 4 received IFU and an Error Correcting Trainer that provides tactile, visual and audio feedback with error correcting technology. The study found that patients’ average errors performed out of 15 steps were highest among Group 1, with 4 average errors, and lowest among Group 4, with .8 average errors. Group 2 and 3 had 2.7 average errors and 1.9 average errors, respectively. Additionally, across all groups, user confidence during treatment increased 86 percent, and anxiety decreased by 15 percent.

The device used in the study was a pen that walked users step-by-step through the training process with audio instructions, detection and notification of an error and how to correct it, and prevention of moving forward in the training until the error is corrected. This pen enables healthcare providers to not only empower patients to use devices correctly, but also to ensure that their treatment outcomes are maximized. From this study, it is apparent that the use of multisensory device trainers that incorporate tactile, visual and audio feedback with error correcting technology significantly increases confidence, lowers anxiety, decreases errors, and improves the learning curve.


The Advantages of a Shortened Learning Curve

Taking the benefits of multisensory training to the next level, healthcare service providers recently developed training systems that leverage multisensory devices and collection of patient data. For example, Noble recently released its Smart Injection Pad, a training device that utilizes audible and error correction technologies to teach patients how to use auto injectors properly, as well as valuable patient data collection. The near field communication (NFC), Bluetooth and WIFI wireless connectivity capabilities for mobile applications track and monitor patients in order to assist in improving adherence and compliance rates. Additional features include pressure sensing technology compatible with shield and button-activated auto injector devices, allowing the system to detect user errors and alert the patient.

Undoubtedly, patients will make errors during the learning process. The key is to ensure that these errors are made during a simulated training environment, and that the training engages the five senses to allow for increased recall and retention of educational messages. Training devices like the multisensory pen used in the Noble study and the recently released Smart Injection Pad training system facilitate active learning scenarios that enable muscle memory and motor skill development.

An educated patient with an optimal learning curve not only results in better treatment outcomes, but also drives brand preference for the healthcare provider. Additionally, patient data collection allows providers to identify which patients require additional training during the onboarding process, thereby streamlining costs and increasing adherence among patients who would have otherwise discontinued treatment. Both advantages serve to bolster providers’ patient onboarding experiences, treatment outcomes, brand preference, and competitive edge.



About Noble®

Noble, the leader in onboarding and device training, is a patient-centered product development and manufacturing company. Noble works closely with pharmaceutical and biotechnology companies to develop educational and training solutions that improve the patient journey.




  1. Makwana, S., Basu, B., Makasana, Y., & Dharamsi, A. (2011, October). Prefilled syringes: An innovation in parenteral packaging. Retrieved from


  1. (2013). Medicines in development – Biologics. Retrieved from


  1. Zambanini, A., Newson, R. B., Maisey, M., & Feher, M. D. (1999, December). Injection related anxiety in insulin-treated diabetes. – PubMed – NCBI. Retrieved from



About the Author

Paul Sullivan, Associate Director of Business Development, Noble


Paul Sullivan is the associate director of business development at Noble (Orlando, FL;, a product development company with a focus in designing and manufacturing drug delivery training and patient onboarding solutions. Prior to Noble, Paul worked at Informed Medical Communications, as a director of business development and client service and before that, as a pharmaceutical sales representative with Procter & Gamble Pharmaceuticals. He holds a Kinesiology degree with honours from the University of Western Ontario.