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Surgery in Africa journal club: A north-south e-learning
collaboration for surgical residents in the COSECSA region.
Harrop TC, O’Flynn E, Howard A, Jani P,
Bekele A, Cameron BH
29% 11% 82% 8%
E-learning in global surgery
“The use of the Internet and multimedia technology to deliver instruction and facilitate learning”
Initially a static library Then Interactive – asynchronous discussion boards Now Web 2.0 – “user-generated content in a virtual community”: blog, wiki, webinar, social media
2006 vs 2016
“The aim of SIA is to build evidence-based surgical and research capacity. SIA aims to do this by making current best evidence, on important surgical topics more accessible, more usable and more relevant to setting.”
[Beveridge, Howard, Jani, Ostrow and many others]
SIA - Surgery in Africa U of T Office of International Surgery
2001
2005
2015
Participation requirement for MCS and FCS trainees
School for Surgeons: a COSECSA / RCSI initiative
Clinical Scenario
Learning objectives
Key resources: Review article
Focus article – (ex. case series, survey, RCT)
Methods article (CJS User’s Guides …)
Participant must: Answer MCQs based on articles
Contribute to Discussion Board
Complete Pre- and Post-tests of EBM knowledge
Complete at least 6 modules
2015 GS and Ortho topics: transfusion, skin grafts, open fractures …10 modules
SIA Journal Club format
To evaluate participants’ knowledge and attitudes to EBM after the SIA Journal Club course.
Methods: 124 SIA course registrants in 2015 included MCS yr 1&2
and FCS trainees. Study sample: 59 MCS yr 2 trainees who completed
at least 6 modules.
We reviewed routinely collected course data: pre- and post-test of EBM knowledge (30 MCQs) resident feedback surveys (Likert scale)
Purpose
Ex. Which is/are important for Evidence-Based Practice? a. Using the best scientific evidence.
b. Considering the individual practitioner’s clinical experience.
c. Considering the patient’s perspective and values.
d. All of the above.
e. None of the above.
Construct validation: “experts” scored 27-29/30
Pre-test (May): 14.1 / 30 (-/+ 4.06)
Post-test (Sept): 19.5 / 30 (-/+ 5.1) [p<0.001]
Results: EBM knowledge (30 MCQs)
Good quality of course (format, content, ease of use): 96%
Attitude towards EBM has changed: 92%
SIA has had a direct impact on clinical work: 98%
69% cited a specific example of change in patient care
SIA has encouraged research ideas: 87%
Online discussions were valuable: 65%
SIA has improved job satisfaction: 66%
Results: Post-course survey
Other outcomes: Seven trainees co-authored one SIA module discussion for ECAJS
Six African surgeons volunteered to help in 2016
Is this a good way to learn content and EBM principles? Is the content relevant to African surgical practice?
Role of local journal club groups (ex. Zambia)
Social presence difficult to generate online
Why were there drop outs? Internet access, speed and cost (download vs. live interaction)
Time requirements: clinical duties, resource overload
Discussion
Formal needs assessment not done However discussion and input from COSECSA leaders
Pretest and survey not rigorously validated Qualitative analysis incomplete
Study sample only included those who completed Don’t know why some dropped out
Limitations
Advantages and potential of SIA Journal Club: Engages dispersed trainees by overcoming geographic/time barriers.
SIA JC is effective in teaching evidence-based practice.
Participant feedback uniformly positive.
Future directions and research questions: How to identify and support potential drop-outs?
How to improve internet access, digital literacy and barriers to participation?
How to improve social presence, interaction and feedback to Discussion Board?
Program evaluation: Can a well-designed and supported e-learning resource change clinical practice?
Conclusions
Collaborators: Andrew Howard (U of Toronto Office of International Surgery)
Tara Aird Harrop MBBS
Eric O’Flynn (Royal College of Surgeons of Ireland)
Pankaj Jani, Abebe Bekele (COSECSA)
McMaster International Surgery Desk
SIA-JC 2016 content developers and moderators: Brian Ostrow, Kabisa Mwala, Vanessa Fawcett, Alan Rogers,
Goran Jovic, Jim Turner, Faith Mchemwe, Joseph Musowoya, James Aird, Mesfin Etsub, Tongai
Acknowledgements:
Thank you