The “3 O’s” Learning Model: Action Research for Continuous Professional/Medical Distance Education (CPDE)

Education Education Intervention Proposal Intervention Proposal

Gurmit Singh, M.EdGurmit Singh, M.EdEducational Researcher & ConsultantEducational Researcher & Consultant

Introduction

How can we… Improve health workers access to education Transfer of knowledge & skills Transform training workshops to reflect the shift

toward continuous learning Improve engagement and motivation Improve effectiveness as learning providers

across time & distance

Goals

Develop HIV health professionals capacity Improve practice Improve patient outcomes

Improve Impact Increase effectiveness in the response to the

HIV/AIDS epidemic Achieve Global Strategic Goals

Challenges

Limited Effectiveness of CME in getting evidence into practice One-off injections of knowledge during workshops and

conferences – training is not learning Although we do needs assessment, there needs to be

more follow up to implement what is taught. Capacity Limitations

Resource limited settings have low capacity for continuous professional education

Need for cost-effective programmes at workplace Balance improving organizational and global intervention

effectiveness with meeting professional learning needs Doing so sustainably and scalably

48 tutors3-4 tutors per

LC (team-teaching + P2P

OM)

48 tutors3-4 tutors per

LC (team-teaching + P2P

OM)

12 tutors +108

members

12 tutors +108

members

PHASES 1 2 3 4 July ’10- July ’11 July ’11- July ’ 12 July ’12- July ’13 July ‘13 -July ’14

PHASES 1 2 3 4 July ’10- July ’11 July ’11- July ’ 12 July ’12- July ’13 July ‘13 -July ’14

1 W + 1 LC 3 W + 3 LC 9 W + 9 LC TBD 1 Course 3 courses 9 courses (2 new, 1 P1) (4 P1&P2, 5 new)

1 W + 1 LC 3 W + 3 LC 9 W + 9 LC TBD 1 Course 3 courses 9 courses (2 new, 1 P1) (4 P1&P2, 5 new)

PARTICIPANTS:Tutors + 12 Fellows + 1 Researcher)SME/Partner Agencies

PARTICIPANTS:Tutors + 12 Fellows + 1 Researcher)SME/Partner Agencies

1Tutor +

12 Fellows

1Tutor +

12 Fellows

3 Tutors +36 members(+ p2p OM)

3 Tutors +36 members(+ p2p OM)

KEY:W = WorkshopsLC = online learning community of practiceP2P OM = peer to peer online mentoring

KEY:W = WorkshopsLC = online learning community of practiceP2P OM = peer to peer online mentoring

Introducing The 3 “O”s: Onsite, Online, Ongoing

Learning in the 21st Century

Continuous Professional Education, as opposed to Training

Changing Notions of Knowledge Conceptions of knowledge and skills as situated, tacit and

practice based Learning = actionable & applied knowledge

Situated in learning ecologies Collaborative Contingent Apprenticed Reflective Socially constructed through dialogue and contextual

problem-solving One-off injections are no longer valid in the new, net-

world of learning through connected networks

Changing Notions of Knowledge

Evidence-based medicine depends on effective transfer of knowledge and skills in order to improve practice and health outcomes

How can one-off conferences & workshops sustain the transfer of learning and improve practice? Must overcome time and distance constraints!

The Need for a Sustainable Solution Health & education fields are searching for a

scalable solution Need to follow the trend and move to more

systemic and sustainable interventions, rather than one-off workshops

Solution: change the concept of Continuing Medical Education (CME) to Continuing Professional Distance Education (CPDE)

CME vs. CPDE: Changing Concept of Health Professional Education

Old CME New CPDE

Setting Hospital/University At Practice & at a distance

Framework Diplomas E-Portfolios

Delivery Lectures Discussion, case-studies, problem-based

learning. IT, blend

Strengths Wise man on stage Relevance to practice, facilitator

Availability One-off, random, not customised

Internet, journals, flexible, personalised

PedagogyDidactic expert Constructivist, social &

informal

What about technology? E-learning, m-learning, e-health, m-health offer

opportunities to reach hard-to-reach professionals who find it difficult to attend workshops or conferences

Using Web-based distance & flexible learning allow providers to reach more members and continue education beyond one-off conference workshops

Digital literacy skills are a priority for health professionals in 21st century

Moves in this direction – e-mentoring, Resource Library, online communities

Why focus on Health Professionals Education now? The NEED!

Lack of skilled HIV Health Professionals is an obstacle to achieving Universal Access

Health Systems Strengthening – health workforce development is a key building block

Current education systems are not transferring skills to improve performance

Existing solutions to health education are obsolete Technology plays an increasing role

Ex. MIT OCW, WikiEducator OER, Virtual Global Health Conference, MSH Virtual Forums, Oncology CoP, World Bank & Rockeffeller Foundation virtual project teams for innovative global problem-solving

Other important factors to consider

President Obama wants PEPFAR to train 140,000 health workers to scale-up treatment access

Pressures to respond to climate change movement & reduce the carbon footprint of conferences

Members & staff say in surveys that they want more access to quicker, personalised, self-directed, flexible learning opportunities at their own pace

Workshops of ‘Training and Hoping’ not a good return on investment due to lack of effectiveness of transfer (K, S, A) to improve practice & patient health outcomes

Effective education programmes require participation of learners in design & thinking, rather than current subject matter experts alone doing the curriculum with little thought for transfer & application

NIH calls for innovative models of medical education and implementation research capacity building

Make a Difference Target Audience

Primarily clinicians & researchers Large % from the global South

Vision To build a worldwide force working together to

sustain country HIV/AIDS responses What do health systems need ?

More flexible, self-confident health professionals who are lifelong learners

‘About 70% of professional learning is self-directed” (Cross, 1991)

Make a difference… Now

How? Pay attention to issues of pedagogical design Frame education around – policy priorities,

address research & capacity gaps, and strategic goals and objectives related to on-going and summative assessment of members

Using e-learning to sustain transfer of K&S to improve performance across distance

Leverage existing workshops programme to scale through sharing curriculum devt. costs

A New ApproachThe 3 “O”s :

Onsite, Online, Ongoing

A Learning Model to Transform

CME into Continuous Professional Distance Education

Intervention Proposal

We propose an educational intervention focused on developing health workers and faculty capacity in CPDE based on the 3 ‘O’s learning model, using change management action research to test the effectiveness of this model.

Project Design: Goals

Build health workers capacity for CPDE Enrich professional culture as a global

learning community Engage participants through continuous

learning communities beyond workshops Optimize knowledge & skills transfer Integrate ICT strategically into education

programmes around scale-up

Key research question to investigate during the pilot:

Could a CPDE Approach to Educational Practice, based around PEPFAR programmes, with a 3‘O’s model - Onsite, Online and Ongoing – improve the effectiveness of HIV Health Professional workforce scaleably by strengthening the impact and delivery of medical and implementation research education?

Specific research questions:

Does the 3 ‘O’s model:1. Lead to an increase in the knowledge, skills and awareness of HIV

medical, public health, and scientific research professionals who participate in these programmes? (Onsite)

2. Enable participants to realise the key objectives of PEPFAR by encouraging engagement in ongoing web-based professional development, thus increasing their capacity to connect, contribute and collaborate, as well as to expand individual knowledge and skills? (Online)

3. Assist participants to develop strategies for advocating, introducing and implementing effective, sustainable and scalable evidence-based HIV/AIDS interventions in their home regions, countries, and communities? (Ongoing)

48 tutors3-4 tutors per

LC (team-teaching + P2P

OM)

48 tutors3-4 tutors per

LC (team-teaching + P2P

OM)

12 tutors +108

members

12 tutors +108

members

PHASES Y1 Y2 Y3 Y4

PHASES Y1 Y2 Y3 Y4

1 W + 1 LC 3 W + 3 LC 9 W + 9 LC TBD 1 Course 3 courses 9 courses (2 new, 1 P1) (4 P1&P2, 5 new)

1 W + 1 LC 3 W + 3 LC 9 W + 9 LC TBD 1 Course 3 courses 9 courses (2 new, 1 P1) (4 P1&P2, 5 new)

PARTICIPANTS:Tutors + 12 Fellows + 1 Researcher

SME/Partner Agencies

PARTICIPANTS:Tutors + 12 Fellows + 1 Researcher

SME/Partner Agencies

1Tutor +

12 Fellows

1Tutor +

12 Fellows

3 Tutors +36 members(+ p2p OM)

3 Tutors +36 members(+ p2p OM)

KEY:W = Workshops with 1 curriculumLC = online learning community of practiceP2P OM = peer to peer online mentoring

KEY:W = Workshops with 1 curriculumLC = online learning community of practiceP2P OM = peer to peer online mentoring

The 3 “O”s: Action Research Project

Learn “Topic” in Workshop (1-2

days) in-country

Learn “Topic” in Workshop (1-2

days) in-country

Select 12Professional Fellows and

conduct needs assessment

Select 12Professional Fellows and

conduct needs assessmentCollaborative

planning with tutors/partners/

pps.

Collaborative planning with

tutors/partners/pps.

Collect data from ongoing practice & Share, Build online

Learning Community

Collect data from ongoing practice & Share, Build online

Learning Community

Phase 1

Learn how to connect

& learn online

Learn how to connect

& learn online

Try out Social Networking

Try out Social Networking

The 3 “O”s: 2011 & Beyond

How to manage risk?

Use change management action research model for pilot project – EMAR model (McPherson & Nunes, 2002)

Gradual evolution & orderly progress to ensure stakeholder consultation & members ownership & buy-in over time

Conduct communications & policy work with NIH/PEPFAR around this innovation to change HIV health professional education and capacity building practices as we know them

Philosophy

Learning Model – 3 ‘O’s

Pedagogical Tactics

Pedagogical Strategy

TasksProgramme

Learning Activities

Learning Outcomes

Course and Programme Evaluation

Organisational Context –PEPFAR

Action Taking

Action Planning

Action Evaluation

Pedagogic Model Educational Setting – Workshops & Learning Communities

Learning by Doing: The EMAR Model to Manage Organizational Change

Implementing the 3 “O”s: Who?

Iniitially piloted with group of 12 professional fellows Chosen through competitive open application

opportunity Great marketing opportunity to generate excitement Help establish proof of concept in Y1

An Advisory Group of HIV experts to collaborate in programme design and implementation.

Partner agencies & universities can be drawn in gradually

Implementing the 3 “O”s: When?

Timeline and scope: 3-4 years Year 1: Establish proof of concept through

CPDE for one topic Year 2: Supervise 3 additional tutors for 3

new focus areas Year 3: Current 3 tutors each train 4

additional tutors and focus areas We will have 12 focus areas.. Imagine the

scale!

Implementing the 3 “O”s: How?

Follow 1 cohort over 3 years with face-to-face workshops at conferences

Sustained with online learning community & social networking (blogs, wikis, mobile)

Action evaluation of ongoing improvements in practice

What’s in it for you? Expand members’ engagement by developing their own learning

solutions through participatory collaboration framework Deliver strategic plan goals with one overarching learning model Harness technology & new media intelligently by building

e-learning competence among membership Innovate to take NIH IS/PEPFAR into the 21st century Build partnerships with top-notch academic partners Play a leadership role in health professional education compared

to competitors Improve organization educational effectiveness for sustainable

impact on members practice Higher return from investment in education than one-off workshops Deepen staff & stakeholders ownership of strategy

What’s in it for participants? Receive support in

- Distance learning with Web 2.0 technologies- Clinical management- Improving self-paced practical skills building through

participation in communities of practice

Credits towards CPDE

Grow to become health professional leaders and improve practice to cascade to their peers

What’s in it for faculty? Receive support in transition to e-learning

- Planning, design & delivery- Online mentoring & tutoring skills- Improving their learning and engagement as educators through

action research

Pride & satisfaction as 21st century health educators

Grow to become educational leaders in curriculum and pedagogical design for CPDE

Increase loyalty to your Programs as fellows and grantees

Potential for Other Spin-Off Benefits

Develop a new IT in Medical Education Module, get it accredited with UK/US university as a CPDE programme for HIV professionals

Replicate in African universities (Ethiopia, South Africa, Malawi, Uganda, etc.) through CPDE Partnerships

Provide consultancy to build capacity of regional institutes as we improve the 3 ‘O’s model & share our lessons from pilot

Summary Using the 3 “O”s Model, you can…

Address the problem of transfer of knowledge & skills Improve PEPFAR learning experiences for members by enabling

& equipping rapid knowledge sharing & skills development on-the-job, practice-relevant, at distance, continuously

Develop your economic viability through better product design Solve health systems problem & create a world-changing

innovation as a social enterprise Imagine an integrated global HIV health professionals education

system Initiate policy & advocacy activities to promote a new way of

learning to realise Universal Access

In times of change, the 3 ‘O’s is an innovation for new problems that transform how we currently

educate ourselves

Thank you for your attention

Please share your thoughts and reactions in an open discussion