Massive Open On Line Course - A Case Study For Antimicrobial Stewardship

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1 Massive Open On line Course [MOOC] for Antimicrobial Stewardship Educating and empowering health care professionals to provide high quality and safe infection prevention and management across all healthcare communities to enhance the health of the populations they serve 1 BACKGROUND Massive Open On line Courses (MOOCs) are web based, open access learning modules that utilise multiple resources and learning media including videos, case studies, electronic textbooks and interactive user forums. The principle of a MOOC is that module content is free at the point of enrolment however fees are frequently charged for enhanced tutorship, examinations or certification. MOOCs offer university standard courses (usually level 5 and above) without the need to complete a complete programme (or even module) of study. MOOC s emerged from the US academic system in the late 2000 s and to date there are currently a number of platforms used to host MOOCs including edx, Coursera, EduKart, UDACITY and FutureLearn. In 2012 the Open University launched FutureLearn, partnering with more than 20 UK and international universities and other institutions such as the British Council, the British Library and the British Museum. 3 The University of Edinburgh became the first UK academic institution to offer MOOC in January Six courses were launched which attracted 308,000 students to enrol. Course tutors stated that more than anticipated input was required for the student forums during the period the module was active. MOOCs are currently offered by UK universities including: Birmingham, Leeds, Leicester, Nottingham, Southampton and Warwick. 3 Data suggests that approximately 10% of those that enrol on a MOOC go on to complete the course. [1] Does this matter? Those that dip in and out will gain knowledge from the course. The proponents of MOOCs, primarily from large elite institutions, welcome the energy, empowerment, increased access, relationship building and community that MOOC's bring to learning, teaching and assessment. However, the sceptics, often from smaller and less prestigious institutions argue that the added value of MOOCs has not been adequately shown, and the MOOC format suffers from 1

2 weaknesses around access, content, quality of learning, poor engagement from weaker learners, accreditation, pedagogy and exclusion of learners without specific network skills [1]. 2 ANTIMICROBIAL STEWARDSHIP Education around antimicrobial prescribing is regarded as one of the key strategies for supporting antimicrobial stewardship activities. A strategy for developing and delivering this [2], within a competency framework [3], has been proposed. The availability of web based resources in relation to antimicrobial stewardship, is of variable quality, hospital and developed country focused, lacks opportunity for interaction, reflection, feedback and assessment, many the sources of funding for developing resources is not transparent or subject to industry bias and none have been subject to appropriate evaluation, in terms of changing practice. [4] The first World Health Organisation (WHO) report on global antimicrobial resistance was recently published [5]. Two of its key recommendations are to work towards ensuring all healthcare and veterinary professional courses worldwide include the diagnosis, management and control of infection, and the use of antibiotics and for the WHO to swiftly identify how it can work collaboratively with learned societies and likewise organisations across the globe to benefit and build on the wealth of accumulated knowledge and experience that already exists. The WHO recommendations provide a clear steer for education needs of prescribers and professionals involved in delivering healthcare. Access, quality, appropriateness of the content for a particular healthcare context and ability to support education in real world practice so as to change behavior remain significant challenges for education providers. Whilst there is no shortage of wellintentioned educational material or courses, there is a clear need for investment in developing and delivering courses that are fit for purpose across all areas. There is no doubt that a collaborative model between academic institutions, professional societies, governmental bodies interested in safety and quality and industry [diagnostics, devices and Pharms] has the capacity and resource to provide adequate resource for the development, maintenance and evaluation of a MOOC on antimicrobial stewardship. The mission of a MOOC for Antimicrobial Stewardship would be to: Educate and empower health care professionals to provide high quality and safe infection prevention and management across all healthcare communities that will enhance the health of the populations they serve. The Stanford, US [ stethe ]MOOC Antimicrobial Stewardship: Optimization of Antibiotic Practices is the first of its kind and has received some positive group feedback: 2

3 this free online course via Coursera is broken into short (less than 15 minutes) delectable chunks of information with some great videos based on recent evidence based guidelines. Furthermore there are case studies and information on antimicrobial stewardship in a wide variety of settings including surgery, long term care facilities, and in pediatrics. Bravo! Although free it is very US focused, specific to hospital prescribing, limited in its range of application of stewardship interventions for diverse problems and provides little guidance on improving or measuring impact on care. There is clearly opportunity for developing something that is free and meets the needs of different learning styles, different healthcare context and systems as well as cultures. The MOOC would have an opportunity to develop learning about improving care through better implementation and measuring of good stewardship. The model would need to develop in incremental phases with step wise implementation that is subject to close monitoring, evaluation and governance. The evaluation of the MOOC would be critical as this is often done inadequately. 4 PROPOSAL We propose a multi stakeholder collaborative incremental approach to developing a MOOC for antimicrobial stewardship. The mission of the MOOC To educate and empower health care professionals to provide high quality and safe infection prevention and management across all healthcare communities that will enhance the health of the populations they serve would be met by the following principles: Free at the point of access A blended approach to learning Provision of core and advance competency learning Clinical care and quality focused Implementation, measurement and feedback focused Fit for diverse learning needs of the team of healthcare professionals and healthcare systems Evaluation of value We aim for this MOOC to improve on those already in the market, some of which are didactic in approach and have little by way of interactive content that will motivate students to return to the course time after time to ensure completion. This MOOC will, in addition to traditional media, offer situational and reflective learning through the use of case studies and case scenario learning. Registrants will be able to participate in regular on line social media hang out sessions to share their experiences, trouble shoot and problem solve together, in addition to dial in expert teaching 3

4 sessions led by leading practitioners in the field. These guest teaching sessions can be tailored to support the needs of the differing communities and level of students engaged internationally in the MOOC. There will be opportunity for students and tutors to host their own online teach and learn sessions, facilitated by the MOOC organisers. In addition to meeting the needs of particular communities and students these dial in sessions will also allow students to experience the views of those working in different environments to their own. We plan to have a development group forum which will draw on the experience of all stakeholders students, tutors, and learned societies, academic institutions to maintain, enhance and develop the MOOC going forward. There is much to consider but the aspiration is to develop an online learning community that synthesizes and benefits from this collaborative, international learning model. Development model Development, funding and delivery of the MOOC would be through partnership between: Lead professional organisation British Society for Antimicrobial Chemotherapy Lead academic institution Under discussion (major UK university) Development and/or sourcing licensing of the infrastructure and IT capability, commissioning, development, quality assurance and hosting of content, management of promotion to, registration by and support of students, identifying mode and method of course evaluation, accreditation and certification. International federal and learned organisations Financial support through direct grants and potential licensing arrangements and for dissemination of the MOOC Other academic institutions (to be identified/approached) Content generation, promotion and assistance in securing student enrolment through adoption of the MOOC as a preferred training course Commercial partners Pharmaceutical industry, diagnostics and device companies etc Financial support through provision of unrestricted educational grants to seed fund development of the MOOC and support continuing development. To assist in dissemination of the MOOC. Background reading: The following are offered by way of background to this proposal and can be accessed below: EDUCAUSE Executive Briefing on MOOCs [pages 6 8] Narrative offering some guidance about the business model for a MOOC, key principles of a 4

5 MOOC for learning leaders and an example of the only antimicrobial stewardship hosted by Standford using the Coursera platform. [page 9] Key issues in relation to articulating the value and funding of a MOOC: How was it? The UK s first Coursera MOOC s assessed. Available at: was it the uks first moocassessed/ article Accessed: January MOOC s: The Complete University Guide. Available at: learning/moocs (massive open onlinecourses)/ Accessed: January CONCLUDING RECOMMENDATION There is clearly an unmet need for education and learning about antimicrobial stewardship that is fit for purpose for a range of health care professionals working in different geographies and with varying levels of resource. This paper identifies a timely opportunity for developing a MOOC in this area, and perhaps use the opportunity to develop a more innovative learning vehicle that has the capability to meets the needs of a diverse range of learning methods/styles. Engagement with a UK based learning platform such as Future learn may be the first step towards this. Our recommendation is that we build a coalition of clinical, academic, industry & governmental partners to take forward our ambition to deliver an innovative, high quality, learner centered on line course that is sustainable and flexible to the need of the healthcare professional. A baseline seed fund target of 375,000 is being sought to develop, test, licence and launch an open access Antimicrobial Stewardship MOOC. A separate business case to identify a sustainable funding stream for maintaining, developing and supporting this and likewise MOOC courses will be developed over the next three months. End 5

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9 STANDFORD MOOC Platform: Coursera Course topic: Medicine & Health This course will offer a practical approach to prescribing antibiotic therapy and development of antimicrobial stewardship across all specialties and settings. STANFORD MOOC COURSE Antibiotics are among the most frequently prescribed classes of drugs and it is estimated that approximately 50% of antibiotic use, in both the outpatient and inpatient settings, is inappropriate. At the same time, in contrast to any other class of drugs, every antibiotic use has a potential public health consequence inappropriate use may not harm only the individual patient, but contributes to societal harm by exerting an unnecessary selective pressure that may lead to antibiotic resistance among bacteria. This course will offer a number of illustrative cases, recognizable to the practicing physician in his or her practice to engage the learners in the thought processes that lead to optimal decision making, improved outcomes of individual patients, and harm reduction vis a vis the bacterial ecology. Learning Objectives Develop skills to apply IDSA guidelines in treating infections such as acute rhino sinusitis, and acute bronchitis. Apply evidence based antibiotic management to treat sepsis. Implement principles of antimicrobial stewardship in your practice. The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. COURSE SYLLABUS Course Outline: Introduction and Pre course Assessment Unit 1: Mechanisms of Microbial Resistance Unit 2: Appropriate Pharmacotherapy Unit 3: ASP in Special Settings Unit 4: Components of an Effective ASP Unit 5: Implementing an Effective ASP Unit 6: Beyond Culture and Sensitivity: the future of ASP, Microbiology and Infection Control COURSE FORMAT Videos by leading experts in the field will provide up to date scientific information and case studies will engage learners in the educational process. Quizzes will facilitate better integration of the information into strategies to apply in practice. 9

10 Bibliography: 1) Literature Review of Massive Open Online Courses and Other Forms of Online Distance Learning. Available at: maturing of the mooc.pdf Accessed: January ) Pulcini C and Gyssens IC. How to educate prescribers in antimicrobial stewardship practices.virulence 2013;4: ) rcompetencies 2_.pdf 4) Pagani L et al. Clin Infect Dis. (2009) 48 (5): ) 10