New education method or tool
Open Access

Preparing for influenza outbreaks: the role of online educational resources [Version 2]

Kieran Walsh[1]

Institution: 1. BMJ
Corresponding Author: Dr Kieran Walsh ([email protected])
Categories: Technology
Published Date: 27/05/2019

Author Revision Notes

More detail has been added on the construction and content of the modules and the nature of the usage. Competing interests statement also added.

Abstract

Introduction

Influenza is a serious disease that can cause considerable morbidity and mortality. It results in regular seasonal outbreaks and occasionally in global pandemics. Healthcare professionals must learn about influenza (both pandemic and seasonal varieties) - however sometimes this disease can cause particular challenges to healthcare professional educators. E-learning modules may be an effective means of educating healthcare professionals on this subject.

Methods

BMJ Learning has published a series of modules on influenza – including seasonal and pandemic influenza. The goals of the modules were to help healthcare professionals learn about the assessment, diagnosis, differential diagnosis, and management of both seasonal and pandemic influenza. All healthcare professional users who completed the modules were encouraged to give free text feedback on the modules. We evaluated the modules by analysing this feedback from a qualitative perspective.

Results    

Feedback to the modules was positive.  Users appreciate the concise, case based and real-life nature of the modules. However, users expect the technology to be reliable and appreciate content in different formats – including text, audio and video. Some users had ongoing clinical learning needs - related to details on the diagnosis, differential diagnosis, and complications of influenza.

Conclusions

There have been hypotheses in the past that e-learning modules could play an important role in infectious disease outbreaks. This paper suggests that they do have a role. To maximise their effectiveness it is likely that modules need to be concise, case based and in a variety of different formats.  

Keywords: Influenza; e-learning

Introduction

Influenza is a serious disease that can cause considerable morbidity and mortality. (Webster and Govorkova, 2014) It results in regular seasonal outbreaks and occasionally in global pandemics. (Rewar et al., 2015) Healthcare professionals must learn about influenza (both pandemic and seasonal varieties); but sometimes this disease can cause particular challenges to healthcare professional educators. This is for a variety of reasons. The population affected by influenza is not only the general public but also healthcare professionals. Healthcare is best learned at the bedside but a pandemic may prevent this. It may result in policies being put in place that prevent students being in direct contact with patients during an outbreak of infectious disease. (Patil and Yan, 2003); Sometimes educators might be too busy or ill themselves, and thus unable to educate students or care for patients. Most of our undergraduate and postgraduate learners are young people and yet these same young people have been disproportionately affected by influenza in the past probably because they had no exposure to and so no immunity from previous similar pandemics. (Walsh et al., 2017) These problems have led educators to consider new ways to educate learners about influenza and other serious infectious diseases. Technology enhanced learning - by means of e-learning - has been suggested as a means of educating large numbers of learners safely in preparation for an outbreak or during an outbreak. (Walsh et al., 2017) However, to date there has been little published evidence as to the utility of e-learning as a means of educating healthcare professionals on this subject.

Methods

BMJ Learning is the online learning website of BMJ. It provides e-learning modules designed to help healthcare professionals learn about a range of clinical subjects. The purpose of the modules is to help healthcare professionals to mobilise evidence based knowledge and so improve the care that they deliver to patients. (Walsh et al., 2010) BMJ Learning has published a series of modules on influenza including seasonal and pandemic influenza. The goals of the modules were to help healthcare professionals learn about the assessment, diagnosis, differential diagnosis and management of both seasonal and pandemic influenza. The modules all contained evidence based and updated content and were all based on practical and actionable guidance. The modules were predominantly interactive and cased based. The modules were all short and take less than an hour for a user to complete. The modules contain clinical images where possible to engage the users. The modules are chunked up so that users can do one bit at a time (and also find out more if they wish to). They are all hosted online and so required an internet connection to work. The modules can be hosted on different platforms but, in this case, they were all hosted on BMJ Learning. The modules are accredited for continuing medical education or continuing professional development. All healthcare professional users who completed the modules were encouraged to give free text feedback on the modules. The users were mainly generalists who work in primary and secondary care. We evaluated the modules by analysing this feedback from a qualitative perspective. This was an evaluation and not a research study. The purpose was to help judge the usefulness and worth of these modules. 

Results

Feedback to the modules was broadly positive. Sixty-six users described the modules as helpful, practical or useful. Fifty-eight users described the modules as good, beneficial or excellent. Twenty-eight users described the modules as informative or interesting. Eight users expressed gratitude for the provision of the modules. Five users described the modules as nice, okay or straightforward. Fourteen users described the modules as short or concise or to-the-point; these users were positive about the concise nature of the content. Three users appreciated the case based and real-life nature of the content. Six users gave positive feedback on the format or presentation of the modules. However, four users had suggestions as to how the format of the modules could be improved: one user stated that they had technology problems with a module; one user suggested that there should be options to learn from text, audio or video; one user requested text subtitles; and one user asked for more questions. Six users made specific comments about what they had learned. Two users stated that the modules met their needs. However, five users made comments that they had ongoing learning needs even after having completed a specific module. The ongoing needs related to details of the diagnosis, differential diagnosis, and complications of influenza. One comment could not be categorised. 

Conclusions

A number of conclusions can be drawn from this analysis. Healthcare professionals will and do use e-learning as a means to prepare themselves for outbreaks of both seasonal and pandemic influenza. The majority find such modules helpful. Users especially appreciate the concise and case based nature of e-learning modules. However, users expect the technology to be reliable and appreciate content in different formats including text, audio and video. Some users had ongoing clinical learning needs - related to the diagnosis, differential diagnosis, and complications of influenza. One option to tackle these needs might be to produce more comprehensive modules but this would not be in keeping with satisfying user needs for concise content. It may be that a programmatic approach is needed with an ongoing series of short modules on various aspects of the disease in question. There are limitations to this analysis. The healthcare professionals were all users of e-learning and indeed of a single provider of e-learning. As such they may not be representative of the wider healthcare professional community. The analysis also looks at modules on a single disease topic; it may not be representative of other disease topics. There have been hypotheses in the past that e-learning modules could play an important role in infectious disease outbreaks. This paper suggests that they do have a role. To maximise their effectiveness it is likely that modules need to be concise, case based and in a variety of different formats.

Take Home Messages

  • Healthcare professionals will use e-learning as a means to prepare themselves for outbreaks of both seasonal and pandemic influenza.
  • Healthcare professionals especially appreciate the concise and case based nature of e-learning modules.  
  • Users expect the technology to be reliable and appreciate content in different formats – including text, audio and video.

Notes On Contributors

Kieran Walsh is Clinical Director at BMJ. He has a great deal of experience of creating and evaluating e-learning resources.

Acknowledgements

None.

Bibliography/References

Patil, NG. and Yan, Y. (2003) 'SARS and its effect on medical education in Hong Kong', Medical Education, Dec 1,37(12), pp. 1127-8. https://doi.org/10.1046/j.1365-2923.2003.01723.x

Rewar, S., Mirdha, D. and Rewar, P. (2015) 'Treatment and Prevention of Pandemic H1N1 Influenza', Ann Glob Health, Sep-Oct,81,5, pp. 645-53. https://doi.org/10.1016/j.aogh.2015.08.014

 

Walsh, K., Sandars, J., Kapoor, S. and Siddiqi, K. (2010) 'Getting NICE guidelines into practice: can e-learning help?', Clinical Governance: An International Journal, 15, 1, pp. 6-11. https://doi.org/10.1108/14777271011017329

 

Walsh, K., Sandars, J. and Nordquist, J. (2017) 'Technology-enhanced learning for healthcare professionals: an essential response to infectious disease pandemics', BMJ Simulation and Technology Enhanced Learning, Published Online, First: 07 October. https://doi.org/10.1136/bmjstel-2017-000236

Webster, RG. and Govorkova, EA. (2014) 'Continuing challenges in influenza', Ann N Y Acad Sci, Sep, 1323, pp. 115-39. https://doi.org/10.1111/nyas.12462

Appendices

None.

Declarations

There are some conflicts of interest:
Kieran Walsh works for BMJ which produces a range of resources in infectious and non-infectious diseases.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

This was an evaluation and not a research study. The purpose was to help judge the usefulness and worth of these modules.

External Funding

This article has not had any External Funding

Reviews

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Barbara Jennings - (26/09/2019) Panel Member Icon
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This interesting article introduces us to the particular rationale for providing e-learning to support the CPD of healthcare professionals who manage seasonal and pandemic influeanza (including availability of learning opportunities during critical outbreak periods).
The platform used and the aims and design of the modules are outlined. However, they are not described in much detail. I was frustrated by this and would like to know more from reading the article e.g. are any metrics collected about learning activity/engagement of users, how many steps in a module, and what exactly were the activities, e.g. how were scenarios presented?
From the results I assumed the course did not have a range of delivery formats or subtitles in the material? If so, this is disappointing from the perspective of equity of access to teaching materials for all learners. It would be fairly standard practice on most mandatory training packages and MOOCs now.
To consider the evaluation in a meaningful way, I also wanted more detail from the results; e.g. broad descriptive statistics about the total number of learners and how many active learners returned feedback. I was also uncertain about the grouped summaries of qualitative feedback. Was each item from a unique learner or were the views of some learners over-represented across topics?
One of the excellent aspects of an online article is there is no shortage of page-space to worry about, which can compromise the full description of methodology in printed journals. Therefore, the author can include a full literature appraisal, full narrative descriptions of methods and rationale, and tabulation of all data (in the main text or as supplementary files) for the sake of their readers. Hopefully, in an accessible way. I would encourage this when describing and evaluating new educational tools.
I think the educational package, and the subject of e-learning when managing outbreaks, will be of interest to a lot of MedEdPublish readers. However, I think readers will need more information if they are to fully understand your educational intervention and its evaluation. Perhaps more detail could be added in a review response?


Possible Conflict of Interest:

For transparency, I am an Associate Editor of MedEdPublish. However, I have posted this review as a member of the review panel and so this review represents a personal, not institutional, opinion.

Ken Masters - (27/05/2019) Panel Member Icon
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I am pleased to see that the author has taken the trouble to submit a revised version of the paper. Unfortunately, the changes are not entirely adequate.

In my review of the first version (https://www.mededpublish.org/manuscripts/1960), I wrote that the revised version would “have to supply far more information about how the evaluation was conducted, the make-up of the users, the construction and content of the modules, the nature of the usage, etc.”

From what I can see, just about the only real change in the 2nd version is these lines:

“The modules were predominantly interactive and cased based. The modules were all short and take less than an hour for a user to complete. The modules contain clinical images where possible to engage the users. The modules are chunked up so that users can do one bit at a time (and also find out more if they wish to). They are all hosted online and so required an internet connection to work. The modules can be hosted on different platforms but, in this case, they were all hosted on BMJ Learning. The modules are accredited for continuing medical education or continuing professional development....The users were mainly generalists who work in primary and secondary care.”

This is a good start, but not enough, as too many details about the evaluation and the makeup of the users are still missing.

So, there has been some attempt at addressing the gaps, but there really could have been more for the reader to have deeper insight into the value of the paper and the course material.
Possible Conflict of Interest:

For Transparency: I am an Associate Editor of MedEdPublish.