Development and impact of a massive open online course (MOOC) for antimicrobial stewardship

Strengthening the role of hospital leadership in infection control (LEAD-IC) - a multimodal educational intervention in German acute care hospitals

BACKGROUND

The effect of leadership support for adherence to infection control and prevention (IPC) measures has been demonstrated. To expand this support, a target group-specific educational study for chief medical officers (CMO) was implemented and its influence on IPC indicators was investigated.

METHODS

A controlled cohort study was conducted between 2018 and 2019. The intervention based on an initial workshop, an e-learning course, and a final meeting. Participants' activities involving IPC management were surveyed. Consumption of alcohol hand rub (AHR) and incidence density of hospital-associated (HA) Clostridioides difficile-associated infections (CDI) were analyzed.

RESULTS

Eight percent of 360 CMOs invited participated in the initial workshop; 70% of those participants registered for the online course. Overall, 43% completed the post-intervention questionnaire, in which 85% of respondents reported increased collaboration with relevant stakeholders. The pre-intervention median AHR consumption was higher in the intervention group than in the control group. Both groups showed an increase (38.6 (interquartile range (IQR) 33.6; 45.0) to 41.9 ml/patient day (PD) (IQR 35.0; 56.6) and 33.4 (IQR 28.3; 40.8) to 35.8 ml/ PD (IQR 31.6; 43.2), respectively). Pre-intervention median HA CDI cases were lower in the intervention group than in the control group. Both groups reported a decrease (0.22 (IQR 0.17; 0.33) to 0.19 cases/1000 PD (IQR 0.15; 0.26) and 0.32 (IQR 0.2; 0.48) to 0.22 cases/1000 PD (IQR 0.11; 0.33), respectively).

CONCLUSION

Multimodal IPC training of CMOs is worthwhile and can lead to changes in IPC-relevant cooperation in hospitals. IPC training of hospital management should be further intensified.

Antimicrobial stewardship in veterinary medicine: a review of online resources

Background

An awareness of antimicrobial resistance and stewardship is important for all prescribers from a One-Health perspective. Educational resources have been created to help veterinary practitioners and encourage an optimized approach to their antimicrobial use.

Objectives

To support veterinarians to select the most appropriate educational resource to meet their personal learning goals in relation to veterinary antimicrobial stewardship (AMS).

Methods

Modular online platforms, developed to promote AMS in veterinary practice (farm and companion animal), were reviewed and key features highlighted, including the required time commitment, resource type, focus and source as well as a subjective evaluation of resource accessibility (according to prior knowledge base).

Results

Five different online courses are described in this educational resource review: Antimicrobial stewardship in veterinary practice; Farm Vet Champions; Farmed Animal Antimicrobial Stewardship Initiative (FAAST); the Pathway of antimicrobial resistance (AMR) for a veterinary services professional; and the VetAMS online learning program. Each of these tools introduces users to key themes of veterinary AMS. Upon completion of any of the courses practitioners should feel confident to assume an active role as proponents of rational antimicrobial use. Significant differences between resources, relating to the focus (companion or farm animal), scope and depth of material covered, are recognized reflecting their respective target audiences.

Conclusions

Several informative and accessible resources, centred on the core principles of veterinary AMS, were reviewed. Key features have been highlighted to inform and guide resource-users towards the most appropriate tool for them. Greater engagement with these educational resources will hopefully contribute to improved antimicrobial prescribing among veterinarians and greater awareness of the importance of stewardship for the profession.

Integration of Massive Open Online Course (MOOC) in Ophthalmic Skills Training for Medical Students: Outcomes and Perspectives

PURPOSE

To integrate a massive open online course (MOOC) into conventional clinical ophthalmology teaching and investigate its impact on the skills of medical students.

METHODS

This was a nonrandomized, prospective, and comparative study. Seventy-six medical students were assigned to 2 groups before their clinical teaching. Some were asked to follow a MOOC for slitlamp microscope examination but used textbook for preview of visual acuity test (SLMM group, n=39), while others were required to take a MOOC for visual acuity test and previewed slitlamp microscopy using textbook (VATM group, n=37). All the students then underwent conventional clinical ophthalmology teaching on slitlamp microscopy and visual acuity test. Their performance was evaluated using Direct Observation of Procedural Skills (DOPS). Students were also asked to complete a 5-item questionnaire about their learning experience and comment on the MOOC.

RESULTS

Students in the SLMM group obtained overall higher scores in the slitlamp practical skills (47.64±4.01 vs 44.68±5.99, P=0.013), while those in the VATM group performed better in the visual acuity test (46.45±4.90 vs 43.78±4.94, P=0.004). MOOC was deemed to increase learning interests (4.13 of 5 points) and motivation (4.01 of 5 points) but was more preferred as an additional tool to traditional teaching methods (4.34 of 5 points) rather than to replace them (2.92 of 5 points).

CONCLUSIONS

MOOC offers an added benefit in improving clinical skills and is worth advocating as an additional tool for clinical ophthalmic education.

Effectiveness of electronic learning for continuing interprofessional education on behavior change of healthcare professionals: A scoping review

Electronic learning (e-learning) for continuing professional education (CPE) in healthcare has been shown to improve learners' satisfaction, attitudes, and performance. E-learning outcomes for continuing interprofessional education (CIPE) are less known, and the features of electronic CIPE programs that promote behavior change are unclear. In this scoping review, we sought to identify the program features and areas of behavior change in healthcare professionals using e-learning for CIPE. PubMed, CINAHL, ERIC, PsycINFO, Cochrane Library databases, and Google/Google Scholar were searched for all English articles published in the last 10 years. From the 32 studies included in our review, eight types of e-learning methods were identified. More than 35,542 healthcare professionals of different professions had participated in the programs. Thirty studies demonstrated positive behavior changes, with four areas of behavior changes identified. The most common area of change was in patient care practices. Five common program features facilitating behavior change were also identified. Most successful programs provided interactive and authentic learning experiences, which promoted direct clinical application. Future researche should include monitoring of sustained behavior changes at work, linked to patient outcomes.

Massive Open Online Courses for Health Worker Education in Low- and Middle-Income Countries: A Scoping Review

Background

Massive Open Online Courses (MOOCs) have the potential to improve access to quality education for health care workers (HCWs) globally. Although studies have reported on the use of MOOCs in low- and middle-income countries (LMICs), our understanding of the scope of their utilization or access barriers and facilitators for this cohort is limited. We conducted a scoping review to map published peer-reviewed literature on MOOCs for HCW education in LMICs. We systematically searched four academic databases (Scopus, Web of Science, PubMed, ERIC) and Google Scholar, and undertook a two-stage screening process. The analysis included studies that reported on MOOCs relevant to HCWs' education accessed by HCWs based in LMICs.

Results

The search identified 1,317 studies with 39 studies included in the analysis, representing 40 MOOCs accessed in over 90 LMICs. We found that MOOCs covered a wide range of HCWs' including nurses, midwives, physicians, dentists, psychologists, and other workers from the broader health care sector, mainly at a post-graduate level. Dominant topics covered by the MOOCs included infectious diseases and epidemic response, treatment and prevention of non-communicable diseases, communication techniques and patient interaction, as well as research practice. Time contribution and internet connection were recognized barriers to MOOC completion, whilst deadlines, email reminders, graphical design of the MOOC, and blended learning modes facilitated uptake and completion. MOOCs were predominantly taught in English (20%), French (12.5%), Spanish (7.5%) and Portuguese (7.5%). Overall, evaluation outcomes were positive and focused on completion rate, learner gain, and student satisfaction.

Conclusion

We conclude that MOOCs can be an adequate tool to support HCWs' education in LMICs and may be particularly suited for supporting knowledge and understanding. Heterogeneous reporting of MOOC characteristics and lack of cohort-specific reporting limits our ability to evaluate MOOCs at a broader scale; we make suggestions on how standardized reporting may offset this problem. Further research should focus on the impact of learning through MOOCs, as well as on the work of HCWs and the apparent lack of courses covering the key causes of diseases in LMICs. This will result in increased understanding of the extent to which MOOCs can be utilized in this context.

Evaluating results of the implementation research MOOC using Kirkpatrick's four-level model: a cross-sectional mixed-methods study

INTRODUCTION

An implementation research (IR) massive open online course (MOOC) was developed by the Special Programme for Research and Training in Tropical Diseases, to address the scarcity of training in low-income and middle-income countries in the field of IR. The Kirkpatrick model was used to evaluate the IR MOOC as it is widely applied for evaluation of training and educational programmes. The Kirkpatrick model evaluates training programmes on four levels: reaction, learning, behaviour and results. This paper addresses the impact of the IR MOOC on participants' professional practice.

METHODS

Findings are based on analysis of survey and interview data collected 1.5-2 years after the conclusion of the two 2018 IR MOOC offerings. Of the 3858 MOC participants, 748 responded to the anonymous online survey and seven of these respondents were interviewed. All data are self-reported.

RESULTS

The IR MOOC was successful in enhancing the professional practice of participants and for their organisations. Over 40% reported modifying or implementing changes in their professional work. Respondents reported that participation in the MOOC had improved their ability to conduct IR, enhanced their professional profiles and increased their opportunities for collaboration, research and job promotion. Respondents stated that the MOOC had improved their work quality and productivity, and allowed them to contribute to research, initiate and develop professional collaborations and train others in IR. Respondents reported an increase in applying for grants and scholarships and presenting and publishing work on IR after participating in the MOOC. Barriers applying the knowledge gained from the IR MOOC were experienced, for example, due to a lack of funding and lack of support from colleagues, managers and organisations.

CONCLUSION

Participants perceived that the IR MOOC was successful in its aims of delivering medium-term and long-term results in relation to their own and their organisations' professional outcomes.

Open Online Courses for Strengthening Laboratory-Based Detection of Antimicrobial Resistance in Pakistan

Introduction

Quality-assured antimicrobial susceptibility testing (AST) depends upon the knowledge and skills of laboratory staff. In many low- and middle-income countries (LMICs), including Pakistan, such types of knowledge and skills are limited. Therefore, the objective of this study was to use openaccess online courses to improve the knowledge of laboratory staff involved in the detection and reporting of antimicrobial resistance (AMR).

Methodology

Seven online modules comprising 22 courses aimed at strengthening the laboratory detection of Antimicrobial resistance (AMR) were developed. The courses were uploaded onto the website www.parn.org.pk. Participants had an option of selecting courses of their interest. Online registration and completion of a pre-course assessment (pre-test) were essential for enrolment. However, participation in post-course assessment (post-test) was optional. The number of registered participants and the proportion of participants who completed each course were computed. A paired t-test was used to assess the increase between mean pre- and post-test scores. The association between the participants working in public vs. private laboratories and course completion rates were determined using the chi-square test.

Results

A total of 227 participants from Pakistan (March 2018 to June 2020) were registered. The largest number of registered participants and the highest completion rate were noted for AST and biosafety courses, while quality-related courses attracted a lower interest. A comparison of pre- and post-test performance using the paired mean score for the individual courses showed a statistically significant (the value of p < 0.05) improvement in 13/20 assessed courses. A higher course completion rate was observed in participants from public vs. private sector laboratories (56.8 vs. 30.8%, the value of p = 0.005).

Conclusions

Our study suggests a promising potential for open online courses (OOCs) toward addressing knowledge gaps in laboratory practice in resource limited settings.

Literature Review on MOOCs on Sensory (Olfactory) Learning

Massive Open Online Courses (MOOCs) have been described as a “next development of networked learning”, and they have the potential to mediate sensory learning. To understand this phenomenon, the present systematic review examines the research techniques, subjects, and trends of MOOC research on sensory learning, in order to provide a thorough understanding of the MOOC relevant to sensory (olfactory) learning phenomena by evaluating 65 (four studies are about multisensorial learning and 61 are about multisensorial empirical MOOCs researches) empirical MOOC studies published between 2008 and 2021 by searching through databases: PubMed, Scopus, Web of Science, and Google Scholar. The results indicated that most studies were based on quantitative research methods followed by mixed research methods and the qualitative research approaches; most of the studies were surveys, followed by platform databases and interviews; almost half of the studies were conducted using at least two methods for data collection: survey and interviews; most were replicated. The most highlighted subjects included student retention, learning experience, social learning, and engagement. Implications and studies into the future have been considered in order to obtain a more evolved understanding of the acquisition of knowledge through the senses.

Digital Teaching in Medical Education: Scientific Literature Landscape Review

BACKGROUND

Digital teaching in medical education has grown in popularity in the recent years. However, to the best of our knowledge, no bibliometric report to date has been published that analyzes this important literature set to reveal prevailing topics and trends and their impacts reflected in citation counts.

OBJECTIVE

We used a bibliometric approach to unveil and evaluate the scientific literature on digital teaching research in medical education, demonstrating recurring research topics, productive authors, research organizations, countries, and journals. We further aimed to discuss some of the topics and findings reported by specific highly cited works.

METHODS

The Web of Science electronic database was searched to identify relevant papers on digital teaching research in medical education. Basic bibliographic data were obtained by the "Analyze" and "Create Citation Report" functions of the database. Complete bibliographic data were exported to VOSviewer for further analyses. Visualization maps were generated to display the recurring author keywords and terms mentioned in the titles and abstracts of the publications.

RESULTS

The analysis was based on data from 3978 papers that were identified. The literature received worldwide contributions with the most productive countries being the United States and United Kingdom. Reviews were significantly more cited, but the citations between open access vs non-open access papers did not significantly differ. Some themes were cited more often, reflected by terms such as virtual reality, innovation, trial, effectiveness, and anatomy. Different aspects in medical education were experimented for digital teaching, such as gross anatomy education, histology, complementary medicine, medicinal chemistry, and basic life support. Some studies have shown that digital teaching could increase learning satisfaction, knowledge gain, and even cost-effectiveness. More studies were conducted on trainees than on undergraduate students.

CONCLUSIONS

Digital teaching in medical education is expected to flourish in the future, especially during this era of COVID-19 pandemic.

A review of web-based application of online learning in pathology and laboratory medicine

Web-based learning applications can support health sciences education, including knowledge acquisition in pathology and laboratory medicine. Websites can be developed to provide learning content, assessments, and products supporting pathology education. In this paper, we review informatics principles, practices, and procedures involved with educational website development in the context of existing websites and published studies of educational website usage outcomes, including that of the authors. We provide an overview with analysis of potential results of usage to inform how such websites may be used, and to guide further development. We discuss the value of educational websites for individual users, educational institutions, and professional organizations. Educational websites may offer assessments that are formative, for learning itself, as practice, preparation, and self-assessment. Open access websites have the advantage of worldwide availability 24/7, particularly aiding persons in low resource settings. Commercial offerings for educational support in formal curricula are beyond the scope of this review. This review is intended to guide those interested in website development to support non-commercial educational purposes for users seeking to improve their knowledge and diagnostic skills supporting careers in pathology.

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Background

Whilst antimicrobial stewardship (AMS) is being implemented globally, contextual differences exist. We describe how the use of a massive open online course (MOOC) platform provided an opportunity to gather diverse narratives on AMS from around the world.

Methods

A free 3 week MOOC titled ‘Tackling antimicrobial resistance: a social science approach’ was launched in November 2019. Learners were asked specific questions about their experiences of AMS via 38 optional free-text prompts dispersed throughout the modules. Content analysis was used to identify key emerging themes from the learners’ responses in the first three runs of the MOOC.

Results

Between November 2019 and July 2020, 1464 learners enrolled from 114 countries. Overall, 199 individual learners provided a total of 1097 responses to the prompts. The diverse perspectives describe unique challenges present in different contexts including ill-defined roles for pharmacists and nurses in AMS; inadequate governance and policy inconsistencies in surveillance for antibiotic consumption and antimicrobial resistance (AMR) in some countries; lack of ownership of antibiotic decision-making and buy-in from different clinical specialties; and human resource and technological constraints. Patients’ knowledge, experiences and perspectives were recognized as a valuable source of information that should be incorporated in AMS initiatives to overcome cultural barriers to the judicious use of antibiotics.

Conclusions

Analysis of learner comments and reflections identified a range of enablers and barriers to AMS implementation across different healthcare economies. Common challenges to AMS implementation included the role of non-physician healthcare workers, resource limitations, gaps in knowledge of AMR, and patient engagement and involvement in AMS.

Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study

Background

To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course.

Objective

The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses.

Methods

The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform’s statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access.

Results

During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course.

Conclusions

The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout.

Driving quality improvement with a massive open online course (MOOC)

Background

Quality improvement (QI) is a priority for national regulatory bodies in health and care in the UK. However, many health and care staff do not know where to go for support in gaining the required skills and knowledge in QI. This paper reviews Improvement Fundamentals, a massive open online course (MOOC), designed to address this gap, run by an improvement team in the national regulatory body.

Methods

In 2015, National Health Service (NHS) Improving Quality (subsequently the sustainable improvement team in NHS England) established Improvement Fundamentals: a programme of online, self-directed courses in QI for those involved in heath or social care. The programme ran in two cycles: twice in 2015, followed by a re-launch in 2018 (this programme also ran into 2019). A mixed-methods evaluation was carried out of the 2015 programme involving surveys, interviews and social listening. The 2018–2019 programme was evaluated using post-course surveys of participants and activity data from the platform.

Outcomes

Since the start of the 2015 programme, 604 improvement projects have been developed, run and submitted for formal assessment, with some demonstrating clear improvements in services. Themes from participant feedback on both programmes have included improved understanding of QI tools and methods; greater energy for QI; a greater sense of community and connectedness in participants’ work and increased confidence in using QI tools and techniques.

Discussion

Both programmes delivered benefits for participants, and the team’s investment in improvement skills on these programmes has helped to increase capability for future change endeavours. The collaborative nature of the programmes has been key to their successes.

Conclusion

Improvement Fundamentals demonstrates that MOOCs can be instrumental in driving forward improvements in health and care. The programmes may have utility as a model for future MOOCs, both in QI and other topics, to help drive further improvements in health and care.

Spreading geriatric oncology culture through professional caregivers: Results of a French massive open online course (MOOC)

Geriatric oncology is based on the synergy between several professionals whose common goal is to improve care for older patients with cancer. This requires sharing a common core of knowledge to facilitate collaboration between them. To date, training in geriatric oncology has been limited in scope and difficult to access for caregivers, particularly nurses and healthcare aides. To meet this need, a massive open online course (MOOC), in geriatric oncology has been developed in France. This kind of course aims to provide simultaneous access for a large number of participants and to foster communication with the pedagogical team through discussion forums. The first session of the MOOC, which has been set up in the Occitania region of France, went online nationwide from March 6 to June 23, 2020. Despite the SARS CoV-2 global health crisis, 1020 people subscribed to the first session and 417 (40.9%) were certified at the end of the course. Most are nurses (35.2%) and work outside Occitania (56.3%). A survey revealed a high satisfaction level regarding relevance of lessons (97.9%), pedagogical quality of teaching team (97.9%), knowledge acquisition (93.6%), meeting learners' needs (90.4%) and practical value of the course (88.3%). This preliminary experience demonstrates the ability of this MOOC to spread the culture of geriatric oncology and the educational potential of this new type of online training.

Current Antimicrobial Stewardship Practice and Education in Russian Hospitals: Results of a Multicenter Survey

Proper antibiotic usage education and training of medical students and healthcare professionals is the cornerstone to implement antimicrobial stewardship (AMS) programs worldwide. We conducted this voluntary and anonymous survey on current and preferred educational provision of AMS in Russia. Among 1358 polled respondents from six participating Centers located in geographically remote Federal Districts of Russia, the majority were nurses (52.8%) and doctors (42.0%). Results of the survey demonstrated better coverage of education in AMS on an undergraduate level (57.1%). More than half of respondents in total (52.4%) stated they had not received any postgraduate training. Those 38.4% respondents who received postgraduate teaching in AMS stated that it had been provided substantially by an employing hospital (28.4%) or by a medical university/college (22.3%). According to the conducted survey, the methods of education in AMS in Russian Federation mainly include traditional face-to-face lectures, presentations and provision with clinical guidelines, recommendations and printed materials. The involvement of e-learning and web-based online approaches was lacking. The survey allowed us the identify the key problems associated with training of healthcare workers in this field, in particular the varying availability of under- and postgraduate education in different parts of Russia.

Evaluation of the Infectious Diseases Society of America's Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows

BACKGROUND

Antimicrobial stewardship (AS) programs are required by Centers for Medicare and Medicaid Services and should ideally have infectious diseases (ID) physician involvement; however, only 50% of ID fellowship programs have formal AS curricula. The Infectious Diseases Society of America (IDSA) formed a workgroup to develop a core AS curriculum for ID fellows. Here, we study its impact.

METHODS

ID program directors and fellows in 56 fellowship programs were surveyed regarding the content and effectiveness of their AS training before and after implementation of the IDSA curriculum. Fellows' knowledge was assessed using multiple-choice questions. Fellows completing their first year of fellowship were surveyed before curriculum implementation ("pre-curriculum") and compared to first-year fellows who complete the curriculum the following year ("post-curriculum").

RESULTS

Forty-nine (88%) program directors and 105 (67%) fellows completed the pre-curriculum surveys; 35 (64%) program directors and 79 (50%) fellows completed the post-curriculum surveys. Prior to IDSA curriculum implementation, only 51% of programs had a "formal" curriculum. After implementation, satisfaction with AS training increased among program directors (16% to 68%) and fellows (51% to 68%). Fellows' confidence increased in 7/10 AS content areas. Knowledge scores improved from a mean of 4.6 to 5.1 correct answers of 9 questions (P=0.028). The major hurdle to curriculum implementation was time, both for formal teaching and for e-learning.

CONCLUSION

Effective AS training is a critical component of ID fellowship training. The IDSA Core AS Curriculum can enhance AS training, increase fellow confidence, and improve overall satisfaction of fellows and program directors.

An international inventory of antimicrobial stewardship (AMS) training programmes for AMS teams

BACKGROUND

Healthcare professionals are increasingly expected to lead antimicrobial stewardship (AMS) initiatives. This role in complex healthcare environments requires specialized training.

OBJECTIVES

Little is known about the types of AMS training programmes available to clinicians seeking to play a lead role in AMS. We aimed to identify clinicians' awareness of AMS training programmes, characteristics of AMS training programmes available and potential barriers to participation.

METHODS

AMS training programmes available were identified by members of the ESCMID Study Group for Antimicrobial Stewardship (ESGAP) via an online survey and through an online search in 2018. Individual training programme course coordinators were then contacted (September-October 2018) for data on the target audience(s), methods of delivery, intended outcomes and potential barriers to accessing the training programme.

RESULTS

A total of 166/250 ESGAP members (66%) responded to the survey, nominating 48 unique AMS training programmes. An additional 32 training programmes were identified through an online search. AMS training programmes were from around the world. Less than half (44.4%) of respondents were aware of one or more AMS training programmes available, with pharmacists more aware compared with medical doctors and other professionals (73% versus 46% and 25%, respectively). AMS training programmes were most commonly delivered online (59%) and aimed at medical doctors (46%). Training costs and a lack of recognition by health professional societies were the most frequently cited barriers to participation in AMS training programmes.

CONCLUSIONS

The development of a systematic inventory of AMS training programmes around the globe identifies opportunities and limitations to current training available. Improving access and increasing awareness amongst target participants will support improved education in AMS.

Massive open online courses for nurses' and healthcare professionals' continuous education: a scoping review

AIM

To map the main characteristics of massive open online courses, and their effectiveness, facilitators and barriers in continuing education among nurses and other healthcare professionals.

BACKGROUND

Online continuous education attracted new attention among educators and managers with regard to how to best design, implement it and evaluate its effectiveness.

INTRODUCTION

No studies to date have mapped the state of research on massive open online courses and the facilitators promoting their effectiveness in continuing education.

METHODS

A scoping review performed in 2020 by following the Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews. Electronic databases were searched for primary and secondary studies, written in English. Identified barriers/facilitators were categorized using a content analysis.

RESULTS

Of the 1149 studies, 31 were included, and the majority had an explorative research design. Massive open online courses documented to date are characterized by their (a) developers' countries and providers, mainly the United Stated and universities, respectively; (b) variety of teaching methods and contents, including infectious diseases; (c) using both qualitative and quantitative assessment methods; and (d) multidisciplinary target audience ranging from 40 to 83 000 participants, including nurses. Facilitators of and barriers to effectiveness depend on their pedagogical background, appropriate course design, delivery and implementation as well as on the learners' profile.

DISCUSSION

Studies available to date are mainly based on experiential projects. A variety of strategies promoting massive online courses' effectiveness have emerged.

CONCLUSION

Some public health issues may benefit from massive education, as a unique system promoting a quick and effective continuous education.

IMPLICATIONS FOR NURSING/HEALTH/SOCIAL POLICY

Clinical nurses, nurse managers and educators should consider available evidence on massive online courses' when making decisions on which strategy to use to maintain competencies. Moreover, as a public health tool, massive online courses should be derived from a strong cooperation between political, scientific and professional bodies.

Immersive virtual environments and embodied agents for e-learning applications

Massive Open Online Courses are a dominant force in remote-learning yet suffer from persisting problems stemming from lack of commitment and low completion rates. In this initial study we investigate how the use of immersive virtual environments for Power-Point based informational learning may benefit learners and mimic traditional lectures successfully. We examine the role of embodied agent tutors which are frequently implemented within virtual learning environments. We find similar performance on a bespoke knowledge test and metrics for motivation, satisfaction, and engagement by learners in both real and virtual environments, regardless of embodied agent tutor presence. Our results raise questions regarding the viability of using virtual environments for remote-learning paradigms, and we emphasise the need for further investigation to inform the design of effective remote-learning applications.

Advocacy for Increased International Efforts for Antimicrobial Stewardship Actions in Low-and Middle-Income Countries on Behalf of Alliance for the Prudent Use of Antimicrobials (APUA), Under the Auspices of the International Society of Antimicrobial Chemotherapy (ISAC)

Antimicrobial stewardship (AMS) is a set of coordinated strategies to improve the use of antimicrobials, to enhance patient outcomes, reduce antimicrobial resistance, and decrease unnecessary costs. The pioneer years of AMS were restricted to high-income countries (HIC), where overconsumption of antibiotics was associated with emergence of multidrug-resistant (MDR) bacteria. AMS in low- and middle-income countries (LMIC) is also necessary. However, programs effective in HIC may not perform as well in LMIC, because (i) While decreased consumption of antibiotics may be an appropriate target in overconsuming HIC, this may be dangerous in LMIC, where many patients die from the lack of access to antibiotics; (ii) although AMS programs in HIC can be designed and monitored through laboratory surveillance of resistance, surveillance programs are not available in many LMIC; (iii) the heterogeneity of health care systems implies that AMS programs must be carefully contextualized. Despite the need to individually tailor AMS programs in LMIC, international collaborations remain highly valuable, through the dissemination of high-quality documents and educational material, that may be shared, adapted where needed, and adopted worldwide. This process, facilitated by modern communication tools, combines many benefits, including: (i) saving time, a precious dimension for health care workers, by avoiding the duplication of similar works in different settings; (ii) taking advantage of colleagues skills, and initiatives, through open access to the work performed in other parts of the world; (iii) sharing experiences, so that we all learn from each others' successes and failures.

Building antimicrobial stewardship through massive open online courses: a pilot study in Macedonia

Background

The global struggle against antibiotic resistance requires antimicrobial stewardship (AMS). Massive open online courses (MOOCs) offer health professionals unprecedented access to high-quality instructional material on AMS; the question is how apprehensible it is to non-native English speakers. Furthermore, to better understand how education interventions promote change towards rational antibiotic prescribing, leading institutions call for studies integrating behavioural science. Research from lower- and middle-income countries is particularly needed.

Objectives

To measure the knowledge improvement from an AMS MOOC, the influence of language, course satisfaction and subsequent effect on intention to change antibiotic prescribing behaviour.

Methods

Fifty-five physicians from Macedonia completed the MOOC. Pre- and post-course knowledge test scores were compared using a one-sample t-test. The effect of a language barrier was assessed using self-reported English level. Scores were compared with participants’ intention to change behaviour in clinical practice.

Results

Scores significantly improved from 77.8% to 82.2%. Participants with a higher English level improved most, while the low-level group showed no significant improvement. Physicians reported a high or very high intention to change behaviour. This was independent of knowledge improvements.

Conclusions

First, lower self-reported English proficiency hindered knowledge acquisition from a MOOC platform. AMS programmes should commit to bridge this barrier so as to enable a global spread of education in AMS. Second, factors underlying the physicians’ intentions to engage in AMS appear to be more complex than simple knowledge improvements. This suggests that less time-consuming interventions could be as effective.

Teaching about antibiotic resistance to a broad audience: a multidisciplinary approach

Education for the general public about antibiotic resistance is advocated as a key component of our response to this crisis. Since this is a multidisciplinary problem encompassing natural, medical and social sciences, it is an educational challenge as both students and lecturers will have vastly different backgrounds in the topics. Here we describe an online multidisciplinary course on antibiotic resistance spanning topics as diverse as chemistry and practical philosophy. The target group was any post-secondary school student and the participating students had different occupations and educational experience. Although as many as 38% of the students were currently studying natural sciences at university, the course included a diverse group with medical professionals (16%) and teachers (6%) making up a significant fraction of the class. The outcomes based on examination and the course evaluations were very positive and we have indications that the information students gained from this course has been spread to others. Unlike other online courses addressing antibiotic resistance, this course is both accessible to a wide range of students and covers a broad range of topics. We advocate courses like ours as an effective tool in educating the public about this crisis.

Addressing Learning Needs on the Use of Metagenomics in Antimicrobial Resistance Surveillance

One Health surveillance of antimicrobial resistance (AMR) depends on a harmonized method for detection of AMR. Metagenomics-based surveillance offers the possibility to compare resistomes within and between different target populations. Its potential to be embedded into policy in the future calls for a timely and integrated knowledge dissemination strategy. We developed a blended training (e-learning and a workshop) on the use of metagenomics in surveillance of pathogens and AMR. The objectives were to highlight the potential of metagenomics in the context of integrated surveillance, to demonstrate its applicability through hands-on training and to raise awareness to bias factors. The target participants included staff of competent authorities responsible for AMR monitoring and academic staff. The training was organized in modules covering the workflow, requirements, benefits and challenges of surveillance by metagenomics. The training had 41 participants. The face-to-face workshop was essential to understand the expectations of the participants about the transition to metagenomics-based surveillance. After revision of the e-learning, we released it as a Massive Open Online Course (MOOC), now available at https://www.coursera.org/learn/metagenomics. This course has run in more than 20 sessions, with more than 3,000 learners enrolled, from more than 120 countries. Blended learning and MOOCs are useful tools to deliver knowledge globally and across disciplines. The released MOOC can be a reference knowledge source for international players in the application of metagenomics in surveillance.

AntibioGame®: A serious game for teaching medical students about antibiotic use

INTRODUCTION

Measures for controlling antimicrobial resistance are urgently required. We describe here AntibioGame®, a serious game for improving the training of medical students in antibiotic use in primary care.

OBJECTIVE

We aimed to design a serious game for antibiotics teaching and to evaluate its usability and playability by medical students.

METHODS

We used various gamification techniques (e.g. use of mascots, avatars, rewards, leader board) and cartoon graphics in the design of AntibioGame®. This game implements clinical case templates built from a list of learning goals defined by a medical team through an analysis of clinical practice guidelines. The game was evaluated by asking medical students to rate their satisfaction and the usability and playability of the game on an electronic form and through group discussions. The electronic form was derived from the MEEGA + scale, a five-point Likert scale including 32 items for assessing both usability and playability.

RESULTS

AntibioGame® is a case-based game in which students play the role of a doctor meeting patients in consultation and helping other health professionals to solve their problems, as in real life. The scenarios are realistic and cover situations frequently encountered in primary care. The 57 medical students enrolled found the game attractive, usable, fun, and appropriate for learning. Game quality was considered "good" (score = 60 on the MEEGA + scale). All the students said they would recommend the game, 96 % liked it and 81 % would use it for revision.

CONCLUSION

AntibioGame® is a promising tool for improving knowledge in antibiotic prescription that could easily be included in multifaceted programs for training medical students.

Study design and protocol for a comprehensive evaluation of a UK massive open online course (MOOC) on quality improvement in healthcare

INTRODUCTION

Massive open online courses (MOOCs) offer a flexible approach to online and distance learning, and are growing in popularity. Several MOOCs are now available, to help learners build on their knowledge in a number of healthcare topics. More research is needed to determine the effectiveness of MOOCs as an online education tool, and explore their long-term impact on learners' professional practice. We present a protocol describing the design of comprehensive, mixed-methods evaluation of a MOOC, 'QualityImprovement (QI) inHealthcare: the Case for Change', which aims to improve learner's knowledge and understanding of QI approaches in healthcare, and to increase their confidence in participating, and possibly leading QI projects.

METHODS AND ANALYSIS

A pre-post study design using quantitative and qualitative methods will be used to evaluate the QI MOOC. Different elements of the RE-AIM (reach, effectiveness and maintenance) and Kirkpatrick (reaction, learning and behaviour) models will be used to guide the evaluation. All learners who register for the course will be invited to participate in the QI MOOC evaluation study. Those who consent will be asked to complete a presurvey to assess baseline QI knowledge (self-report and objective) and perceived confidence in engaging in QI activities. On completion of the course, participants will complete a postsurvey measuring again knowledge and perceived confidence. Feedback on the course content and how it can be improved. A subset of participants will be invited to take part in a follow-up qualitative interview, 3 months after taking the course, to explore in depth how the MOOC impacted their behaviour in practice.

ETHICS AND DISSEMINATION

The study has been approved by the University of Bath Human Research Ethics Committee (reference: 2958). Study findings will be published in peer-reviewed journals, and disseminated at conference and departmental presentations, and more widely using social media, microblogging sites and periodicals aimed at healthcare professionals.

Genomic Education at Scale: The Benefits of Massive Open Online Courses for the Healthcare Workforce

To support the delivery of the UK’s 100,000 Genomes Project, Health Education England’s Genomics Education Programme developed a suite of resources, including a 3-week Massive Open Online Course (MOOC) on whole genome sequencing via the FutureLearn platform. This MOOC is a synchronous learning event, with course educators and mentors (NHS healthcare science trainees in genomics) facilitating the experience in real time. Crucially, the platform allows participants to interact and learn from each other’s experiences. The evaluation of the course was considered from the learners’ and mentors’ perspectives. Perceptions of course relevance were examined through analysis of learner comments made throughout the course and responses to an end-of-course survey. Evaluation of mentors’ experiences focused on how prepared they felt to undertake their role and the value and benefit of their experience. Data was collected through a mixed methods study after the first two runs of the course. Here we present findings from 440 learners who provided end-of-course reflections, 360 learners who completed the post-course survey and 14 mentors who facilitated the course. The course met learners’ needs by providing a greater understanding of whole genome sequencing and the application of this technology in healthcare. Learners also highly valued the engagement with mentors. Mentors appreciated the experience and identified areas of professional development gained through the mentoring experience. Our findings show that a team of specialist healthcare course mentors engaging with a range of different healthcare professional MOOC learners in online conversation can enhance the learners’ experiences and provide a beneficial continuing professional development opportunity for mentors.

Antimicrobial stewardship in South Africa: a scoping review of the published literature

Objectives

To map published data of antimicrobial stewardship (AMS) interventions that are currently being carried out in hospitals and clinics in the public and private health sectors of South Africa in line with the antimicrobial resistance (AMR) strategy of South Africa.

Methods

A systematic scoping review was conducted to identify AMS initiatives in the public and private health sectors of South Africa for the period 1 January 2000 to 31 March 2019. An electronic search of databases was made including PubMed, Scopus, a key medical journal (South African Medical Journal), University of KwaZulu-Natal (UKZN) WorldCat iCatalogue and AMR networks: Federation of Infectious Diseases Societies in South Africa (FIDSSA). Reference lists of published articles were also reviewed for inclusion. Keywords included ‘antimicrobial antibiotic stewardship South Africa’.

Findings

Of a total of 411 articles, using a stepwise screening process, 18 articles were selected for inclusion in the review. The interventions/initiatives were divided into four broad categories: (i) AMS intervention: prescription audits and usage; (ii) AMS intervention: education and its impact; (iii) other AMS interventions; and (iv) the role of different healthcare professionals in AMS.

Conclusions

The data identifies a need for and the value of AMS in both the public and private health sectors of South Africa. Initiatives are carried out across both sectors but more attention needs to be focused on AMS implementation in line with the National AMR Strategy of South Africa. Collaboration between the different sectors will aid in overcoming the AMR challenge.

These may not be the courses you are seeking: a systematic review of open online courses in health professions education

INTRODUCTION

Open Online Courses (OOCs) are increasingly presented as a possible solution to the many challenges of higher education. However, there is currently little evidence available to support decisions around the use of OOCs in health professions education. The aim of this systematic review was to summarise the available evidence describing the features of OOCs in health professions education and to analyse their utility for decision-making using a self-developed framework consisting of point scores around effectiveness, learner experiences, feasibility, pedagogy and economics.

METHODS

Electronic searches of PubMed, Medline, Embase, PsychInfo and CINAHL were made up to April 2019 using keywords related to OOC variants and health professions. We accepted any type of full text English publication with no exclusions made on the basis of study quality. Data were extracted using a custom-developed, a priori critical analysis framework comprising themes relating to effectiveness, economics, pedagogy, acceptability and learner experience.

RESULTS

54 articles were included in the review and 46 were of the lowest levels of evidence, and most were offered by institutions based in the United States (n = 11) and United Kingdom (n = 6). Most studies provided insufficient course detail to make any confident claims about participant learning, although studies published from 2016 were more likely to include information around course aims and participant evaluation. In terms of the five categories identified for analysis, few studies provided sufficiently robust evidence to be used in formal decision making in undergraduate or postgraduate curricula.

CONCLUSION

This review highlights a poor state of evidence to support or refute claims regarding the effectiveness of OOCs in health professions education. Health professions educators interested in developing courses of this nature should adopt a critical and cautious position regarding their adoption.

Decomposing the Complexity of Value: Integration of Digital Transformation of Education with Circular Economy Transition

In this article, we highlight the pressing need for integrating the windows of opportunities that digital transformation of education opens up with circular economy education to accelerate the achievements of sustainability outcomes. Circular economy transition, as a multi-scalar process, relates to several contexts, e.g., product, firm, industry-level transformations ranging from designing local socio-technical solutions to greening global value chains, with multi-level policy and business implications for finance, production, distribution, consumption that are fundamentally consequential to everyday life, work and learning. Drawing on theories of neo-capital, multi-level perspective and structuration, and as methodology, using content analysis and qualitative meta-synthesis of scientific publications in digital education for sustainability, we blended our findings into multi-level, multi-domain structuration blueprints, which capture the complexity of value emanating from the interactions among external structures, internal structures of agents, active agencies and outcomes, for circular economy open online education and massive open online course instructional designs. We conclude that learning and creating multiple values to increase social–ecological value, complementarily to economic value, necessitate activating the complexity of value embedded in digital education and circular economy transitions with cu2005mizable niches of learning preferences and journeys of individuals and groups, within broader (and evolving) technological, organizational and institutional structures.

Construction of higher education knowledge map in university libraries based on MOOC

Purpose

The purpose of this study was to establish a massive online open course (MOOC)-based map of higher education knowledge and apply it to university libraries. It hoped to provide more targeted and personalized learning services for every learner.

Design/methodology/approach

In this study, MOOC and university library information services were outlined, the development status of MOOC at home and abroad and the development of university library information services were introduced, and the necessity and significance of MOOC in developing information services in university libraries were analyzed. What is more, the knowledge map of university libraries was explored. The four modules include the construction of data sets, the identification of related entities from plain text, the extraction of entity relationships and the practical application of knowledge maps. For the logical relationship of the course, a combination of knowledge base and machine learning was adopted. In the knowledge map application module, the knowledge map was visualized. Aiming at the generation of personalized learning scheme, a prior data set was constructed by means of the knowledge base. The original problem was considered as a multi-classification problem. K-nearest neighbor classifier divided all courses into four academic years to obtain all courses. According to the course stage, the personalized learning scheme of some majors in higher education was obtained.

Findings

The experiment showed that it was feasible to apply the higher education knowledge map based on MOOC to university libraries. In addition, it was effective to divide the course into four stages by classifier. In this way, the specific professional training program can be obtained, the information service of the university library can be improved, and the accuracy and richness of the entire learning program can be increased.

Research limitations/implications

Due to the limitations of conditions, time and other aspects, there were not many opportunities to visit the field library, which led to limited level and imperfect research. There were many proper nouns and professional terms in foreign references, but my English translation ability was limited. The relevant investigation on foreign studies may not be detailed and comprehensive enough, and the analysis and induction of influencing factors of university library information service may not be rigorous and concise enough.

Practical implications

As the base of university information dissemination, the university library is the source of knowledge. At the same time, it is also the temple of students’ independent learning and the media of mainstream culture and improving its own information service level is also in line with the trend of The Times. Under this background, this research studied the influence of MOOC on university library information service and focused on the challenges and opportunities faced by university library information service in the MOOC environment, so as to continuously improve its cultural serviceability and better serve teachers and students.

Originality/value

Since the birth of MOOC, they have exerted great influence and enlightenment on universities and relevant educational institutions within a few years. European and American universities take an active part in the construction of the MOOC platform and explore how to make better use of the library to build MOOC resources in practice. It is also a hot topic for university libraries to participate in the construction of MOOC information resources. Therefore, the study of this topic has both theoretical and practical significance.

Implementation of antibiotic stewardship in different settings - results of an international survey

Background

Antibiotic stewardship interventions are being implemented across different healthcare settings. We report the findings of a global survey of healthcare professionals on the implementation of antibiotic stewardship programmes.

Methods

Learners of a Massive Online Open Course (MOOC) on antibiotic stewardship were invited to complete an online survey on the core available organisational resources for stewardship. The categorical variables were analysed using chi-squared test, and Likert questions were analysed using an ordinal regression model. The p-values were considered as two-tailed. Significance was set at p-value of < 0.05.

Results

The response rate was 55% (505/920), from 53 countries. The responders were 36% (182) doctors, 26% (130) pharmacists, 18% (89) nurses and 20% (104) other (researchers, students and members of the public). Post-graduate training in infection management and stewardship was reported by 56% of doctors compared with 43% (OR 0.59, 95%CI 0.35–1.00) nurses and 35% (OR 0.39, 95%CI 0.24–0.62) of pharmacists. Hospitals were significantly (83% in teaching hospitals, 79% in regional hospitals, p = < 0.01) more likely to have antibiotic policies, when compared to primary care. A surveillance mechanism for antibiotic consumption was reported in 58% (104/178) of teaching hospitals and 62% (98/159) of regional hospitals. Antimicrobial resistance, patient needs, policy, peer influence and specialty level culture and practices were deemed important determinants for decision-making.

Conclusion

Postgraduate training and support in antibiotic prescribing remains low amongst nurses and pharmacists. Whilst antibiotic policies and committees are established in most institutions, surveillance of antibiotic use is not. The impact of specialty level culture, and peer influence appears to be important factors of antibiotic prescribing.

The State of Education and Training for Antimicrobial Stewardship Programs in Indian Hospitals-A Qualitative and Quantitative Assessment

Background: To understand the role of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in Indian healthcare organizations. Methods: Mixed method approach using quantitative survey and qualitative interviews was applied. Through key informants, healthcare professionals from 69 hospitals (public & private) were invited to participate in online survey and follow up qualitative interviews. Thematic analysis was applied to identify the key emerging themes from the interviews. The survey data were analyzed using descriptive statistics. Results: 60 healthcare professionals from 51 hospitals responded to the survey. Eight doctors participated in semi-structured telephone interviews. 69% (27/39) of the respondents received E&T on AMS during undergraduate or postgraduate training. 88% (15/17) had not received any E&T at induction or during employment. In the qualitative interviews three key areas of concern were identified: (1) need for government level endorsement of AMS activities; (2) lack of AMS programs in hospitals; and, (3) lack of postgraduate E&T in AMS for staff. Conclusion: No structured provision of E&T for AMS currently exists in India. Stakeholder engagement is essential to the sustainable design and implementation of bespoke E&T for hospital AMS in India.

Protocol for a mixed-methods evaluation of a massive open online course on real world evidence

INTRODUCTION

Increasing number of Massive Open Online Courses (MOOCs) are being used to train learners at scale in various healthcare-related skills. However, many challenges in course delivery require further understanding, for example, factors exploring the reasons for high MOOC dropout rates, recorded low social interaction between learners and the lack of understanding of the impact of a course facilitators' presence in course engagement. There is a need to generate further evidence to explore these detriments to MOOC course delivery to enable enhanced course learning design. The proposed mixed-methods evaluation of the MOOC was determined based on the MOOC's aims and objectives and the methodological approaches used to evaluate this type of a course. The MOOC evaluation will help appraise the effectiveness of the MOOC in delivering its intended objectives. This protocol aims to describe the design of a study evaluating learners knowledge, skills and attitudes in a MOOCs about data science for healthcare.

METHODS AND ANALYSIS

Study participants will be recruited from learners who have registered for the MOOC. On registration, learners will be given an opportunity to opt into the study and complete informed consent. Following completion of the course, study participants will be contacted to complete semistructured interviews. Interviews will be transcribed and coded using thematic analysis, with data analysed using two evaluation models: (1) the reach, effectiveness, adoption, implementation, maintenance framework and the (2) Kirkpatrick model drawing data from pre and post-course surveys and post-MOOC semi-structured interviews. The primary goal of the evaluation is to appraise participants' knowledge, skills and attitude after taking the MOOC.

ETHICS AND DISSEMINATION

Ethics approval for this study was obtained from Imperial College London through the Education Ethics Review Process (EERP) (EERP1617-030). A summary of the research findings will be reported through a peer-reviewed journal and will be presented at an international conference.