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How to make an effective eLearning module If you would like help with these questions, this module is for you! How will the learner track their progress.

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Presentation on theme: "How to make an effective eLearning module If you would like help with these questions, this module is for you! How will the learner track their progress."— Presentation transcript:

1 How to make an effective eLearning module If you would like help with these questions, this module is for you! How will the learner track their progress – so that they will be confident that they have achieved something? Where do I start? How can eLearning make the content more interesting? I want to make a module that will be an effective learning resource. But …

2 Background -1 eLearning modules aim to fill several gaps: Provide health-care students and front-line health workers in resource poor countries with learning resources that will be effective in improving health outcomes Involve health staff in resource-poor countries in making “home-grown” learning resources so that the resources are directly familiar to “real-life”, day-to-day health care in their own setting they build their expertise in developing effective resources for adult learners Take advantage of digital technology and copyright-free content to: develop short learning modules that actively engage the learner include formative assessment so that the learner can track their progress use simple, widely available software so that others can adapt the materials for teaching other target groups The modules are usually designed to be studied mainly by a single learner sitting at a computer screen. However, they can be used to generate discussion topics or exercises that can be suitable for groups of learners.

3 Background -2 Remember that the overall aim is to build the confidence of your learner to deliver health care more effectively. The learner should enjoy your module and feel that they have achieved something valuable by completing it. Therefore, make sure that the learning outcomes are appropriate for your learner and that the module allows them to achieve new knowledge and skills with confidence. This module describes some basic principles and approaches that may help you to develop a learning resource that is effective for adult learners. It complements the module by Jess Griffiths that covers the technical “How to do it” issues using MS PowerPoint. But beware! This module is for guidance only. There are many different ways to teach – and you should feel free to develop your own style and innovative methods for eLearning!

4 Learning outcomes By the end of this module and the accompanying module by Jess Griffiths, you should be able to: Write concise learning outcomes (LOs) that state clearly what the learner should be able to do after completing your module Present content in an interesting way that will engage the learner Design an assessment that will allow the learner to assess what new knowledge and skills they have acquired

5 Before you start Have a clear idea of who your learner is. What knowledge and skills do they have already? How should your module be designed to be most appropriate for their learning needs? Always keep in your mind’s eye a mental image of your learner sitting at the computer studying your module. Of course, we all learn from multiple sources (textbooks, websites, conversations with experienced colleagues and, most importantly, from patients themselves). You should encourage your learner to seek-out other information to complement your module. However, the module must be self-contained and contain all that the learner needs to meet its specific learning objectives.

6 Title slide The title should state clearly what your module is about. This first slide is the advertisement for your module. It is your best chance to capture your learner’s attention and make them want to study the module. So make it as attractive and informative as possible!

7 Learning outcomes (LOs): start here! This is the most difficult bit! Although you may have a clear idea of what your module aims to achieve, writing down clear LOs needs careful thought and is the essential first step in module development. Once you are happy with your LOs – stick to them and do not allow the module to wander into other areas Do not start to develop your module until you have identified a few (usually 3-4) clear LOs – and perhaps agreed them with your supervisor The LOs are vital because they determine precisely the content of the module determine precisely the assessment

8 What are good LOs? Good LOs should clearly state what the learner should be able to do by completing the module They should be “active” - so that the learner will be able to assess for themselves whether or not they have achieved the LOs But how do you write a good LO?

9 d Are these LOs good or bad? A module aims to improve knowledge of the diagnosis of tuberculosis (TB). Decide whether each of the following LOs is good or bad. Then click on the square to see our assessment. At the end of this module, you should: a.Know about the diagnosis of TB b.Understand how TB is diagnosed c.Be able to describe the methods used to diagnose TB d.Be able to describe how CXR and sputum examination are used in the diagnosis of TB c b a

10 LOs – a few tips Try rewording the LOs a few different ways to get the balance right between sufficient detail but not too long-winded It is often useful to include numbers in LOs; for example “describe the 3 major ways that…” Tempt the learner to continue with the module. Say enough to interest them, but keep the best bits for the content! Use “active” words such as “discuss” and “explain”

11 Content The content is the information that you want the learner to acquire. Clearly, this information has to be accurate and up-to-date. The content should also be clearly referenced so that the learner is able to check the source of the information. Start by identifying a small number of reliable and up-to-date sources of information. It is often useful to use a recent review as the main source of your content.

12 Copyright There is no problem with reproducing other people’s material as long as you reference its source The main problem comes with reproducing images (figures, photographs etc.) Although it is tempting to “cut and paste” highly polished images from books or the internet into your module, these are usually not quite right for the point you want to make or are too complicated. Although “a picture is worth a thousand words”, complex diagrams without adequate explanation are just confusing. Click here for an example request to use an image for your module Your own simple images that directly show what you are trying to teach are usually much better. You can make these by using the simple autoshapes and drawing tools available in MS PowerPoint or draw them on paper and scan the image. Simple scanned line diagrams can be coloured easily using MS PaintBox to get very professional results! Always a controversial area! If there are existing images that are exactly right for your purpose, then you must get permission from the author or publisher to use it in your module.

13 Clinical images Carefully-selected, high- quality images that demonstrate key clinical signs greatly improve the effectiveness of learning resources. Digital photography has made obtaining clinical images much easier. Taking clinical images that are effective for teaching is not easy - but we all improve with practice! Click here Click here for an example of a consent form for medical photography. We consider that it is only acceptable to show clinical images if the patient or their parents or carers have given you permission to use the image for teaching purposes. Wherever possible, avoid images that allow the person to be identified. For example, if you want to demonstrate pallor by showing the palm of the hand, then just show the palm rather than the whole person. Click here Click here for an example of a statement to use in your module regarding permission to use clinical images.

14 How to make content interesting There are many ways of presenting information in an interesting way. The key is to actively involve the learner – rather than just “spoon feed” information. Remember that the information is probably already available in a book or on a website. Your module needs to go beyond just presenting information. It needs to be an active learning tool. The LO for this example is: “Be able to discuss the pathophysiological principles that underlie the fluid management of severe dehydration in severe acute malnutrition” The following slides give 3 suggestions as to how to present information in a way that engages the learner. An example about the fluid management of severe dehydration in severe acute malnutrition is used to illustrate each approach. Incorrect management is common and may result in the death of the child. This example aims to change practice by increasing understanding of the underlying principles.

15 Engaging the learner - 1 This approach is best when the learner has little or no existing knowledge of the topic. “Show and test” First, present the information just as it might appear in a book or on a website. Remember to include good images to make the information as engaging as possible! Then, re-enforce the learning by repetition by engage the learner in some interactive formative assessment Use the answers as an opportunity to further re- enforce and extend the learning Click here for an example of this approach

16 Engaging the learner - 2 “Have a go” This approach is appropriate if the learner already has some knowledge of the topic and you aim to build on this existing knowledge Ask them to provide some information “from scratch” and then compare their answers with the correct answers Set the level of difficulty so that the learner performs fairly well (gets about 60% right). He/she is then encouraged to learn more (up to 100% correct) and continue with the module. Click here to see the same severe dehydration in SAM example presented in this way

17 Engaging the learner - 3 “Making it real” This is a higher level of learning which requires the learner to apply their existing knowledge to solve a problem You present a “real life” scenario which mimics as closely as possible the learner’s day-to-day work You present a problem and then ask the learner to work through to a solution This prompts the learner to think about the information carefully and work-out for themselves the important “take- home” messages This also provides an opportunity to promote good clinical practice (e.g. multidisciplinary team working, clinical audit) Click here to see the same severe dehydration in SAM example presented in this way

18 Engaging the learner - summary These are only a few suggestions and there are many different approaches. Do invent your own methods for presenting information in an engaging way! A few general comments on presenting information: Do not use too many different methods within a single module. To avoid confusing the learner, allow them to become familiar with just 2-3 different methods in your module. Think carefully about the likely learning style of your learners and also how best this particular information might be presented. Although effective, “active” learning is quite tiring. Including some “spoonfeeding” of information as well as one or two more demanding methods is often best. Remember that the aim of the module is for the learner to achieve the learning outcomes – not to demonstrate your skills as a teacher!

19 Assessment - 1 In most cases, the assessment for the module should be “formative”. This is purely for the learner’s benefit – so that he or she can track their own progress.* The assessment should be limited to the LOs. The purpose is to allow the learner to confirm that they have achieved the LOs. The learner should perform well in your assessment. This confirms that your module has been effective! * “Summative” assessment is for formal examination purposes and will not be covered here

20 Assessment - 2 You have already met some examples of formative assessment in this module. The accompanying module by Jess Griffiths provides you with a simple template for writing “pick the best of 5 options” questions. This can easily be adapted to “true or false” or other simple formats. These simple formats can be used just to test recall of facts. At a more advanced level, your questions can test the learner’s understanding of the information. Two simple techniques to make these simple formats more effective provide the leaner with explanations when they select the wrong answer take advantage of a correct selection by providing some additional information Now use Jess Griffiths’ module “International Health Template Module”

21 Beyond individual learning Although eLearning modules are usually designed for study by an individual sitting at a computer, most topics demand the extension of the learning to group activities. In our example regarding the management of severe dehydration in SAM, it is likely that many of the staff working in a health centre would benefit from the module – and not just the person who has managed to get time on the computer. Try to think of ways that the key messages acquired by the individual learner might be passed-on to their peers. Provide the person who has completed your module with some help in spreading the word. Examples might be –providing a case scenario for discussion at a team meeting –including a simple questionnaire that captures information about current knowledge and practice and identifies gaps –including a simple management protocol that could be adapted and then printed-out and posted in the ward or treatment room

22 Some final remarks Please remember that there are no right answers to eLearning. You should look at as many other examples as you can, experiment and develop your own approaches. The key to success is to have a clear idea of the needs of your target audience, carefully designed and clearly stated LOs and then an engaging module that allows the learner to achieve the LOs with confidence. Finally, we hope that you have found this module useful and enjoy developing your own eLearning module. We would be very grateful for any comments, corrections or suggested additions to this module. Please send an to And, most important of all, good luck!

23 Answer to question 1a At the end of this module, you should: a.Know about the diagnosis of TB We thought that this was a bad LO. It has two main problems: -It is vague. The learner already knows from the title of the module that it is about the diagnosis of TB. This LO does not give any more information. -It is “inactive” – it is difficult to for the learner to judge whether or not they “know” something Back 

24 Answer to question 1b At the end of this module, you should: b. Understand how TB is diagnosed We thought that was also a poor LO. It has the same main problems as the previous LO: -It is vague so does not add anything to the title of the module -Like “knowing” something, it is also difficult for the learner to judge whether or not they “understand” something Back 

25 Answer the question 1c At the end of this module, you should: c. Be able to describe the methods used to diagnose TB We thought that this was a much better LO. It gives the learner a better idea of what they should be able to do after studying the module. They can imagine themselves describing the methods used to diagnose TB to a colleague. In fact, they could even practice doing it back to themselves in front of a mirror! Back

26 Answer to question 1d At the end of this module, you should: d. Be able to describe how CXR and sputum examination are used in the diagnosis of TB We thought that this was an excellent LO. It is sufficiently detailed for the learner to know exactly what they should achieve but is not too long and detailed. In addition, reading the LOs has taught them something already. They have already acquired some knowledge that will be built-on by the module content. Repeating information in this way is very effective. If this information is repeated again in the summary at the end of the module, then the classical advice for effective teaching has been followed: “Say what you are going to say, say it, and then say what you have said” Of course, formative assessment within the module is another way to re- enforce this knowledge – see later! Back

27 Example of medical photography consent form > Consent for Medical Photography Name of patient:Hospital number:Date: I would like your consent to take some photographs of you and perhaps your X rays or other investigations to prepare teaching materials for health care students and health professionals. The photographs may be used to illustrate lectures and published in the medical literature. They may also appear in teaching modules that we make available on the internet. There will be no record of your name in any of the materials that we produce. Under no circumstances will we sell your pictures nor will they be used in any commercial enterprise. I would be grateful if you would consent to photographs being taken and used for teaching. You are completely free to refuse and this will not affect the treatment or care that you receive in any way. Signature / thumb print of person giving consent………………………… Patient or state relationship to patient:…………………………………….. Person obtaining consent: Name ……………………………..Job title:……………………………. Signature ……………………………… Back

28 Permission to use clinical images Here is an example of a statement to include in your module. Please note that permission was granted from patients, their parents or carers to use the images in this module for teaching purposes only. The images should not be used for any other purpose including any commercial enterprise. Back

29 Fluid management of severe dehydration in severe acute malnutrition (SAM) A child with SAM and diarrhoea is assessed to be severely dehydrated. How is physiology deranged in children with SAM and how does this affect their management? Dehydration is difficult to diagnose in SAM and it is often overdiagnosed Although plasma sodium may be very low, total body sodium is often increased due to –increased sodium inside cells –additional sodium in extracellular fluid if there is nutritional oedema –reduced excretion of sodium by the kidneys Also, cardiac function is impaired in SAM This explains why treatment with IV fluids can result in death from sodium overload and heart failure. The correct management is reduced sodium oral rehydration fluid (ORF; e.g. ReSoMal) given by mouth or naso-gastric tube if necessary. The volume and rate of ORF are much less for malnourished than well-nourished children* IV fluids should be used only to treat shock in children with SAM who are also lethargic or have lost consciousness! Markedly prolonged skin pinch in a severely malnourished child with diarrhoea *Pocket book of hospital care for children.

30 Questions: Fluid management of severe dehydration in a child with SAM Decide if each of the following statements is true or false. Then click to see the answer. Low serum sodium is due to low total body sodium A bolus of IV fluid is appropriate to treat shock if the child is also lethargic or has lost consciousness WHO oral rehydration fluid is appropriate c b a Next

31 Answer to question a In the management of severe dehydration in a child with SAM: a)Low serum sodium is due to low total body sodium False. Although serum sodium is often low or very low in children with severe malnutrition, total body sodium is often increased due to –Increased intracellular sodium; in the “sick cell syndrome” in malnutrition the cellular anion exchange pumps fail and sodium leaks into cells –Additional sodium in extracellular fluid if there is nutritional oedema –Reduced renal excretion of sodium  Back

32 Answer to question b In the management of severe dehydration in a child with SAM: b) A bolus of isotonic fluid IV is appropriate to treat shock if the child is also lethargic or has lost consciousness True: In shock, an IV fluid bolus (e.g. Ringer’s lactate with 5% glucose) should be administered rapidly.* However, IV fluids are contraindicated in the absence of shock. Severe dehydration should be managed by oral rehydration fluids. Back *Pocket book of hospital care for childrenPocket book of hospital care for children

33 Answer to question c In the management of severe dehydration in a child with SAM: c) WHO oral rehydration fluid is appropriate False. WHO ORF contains too much sodium and too little potassium. Because of increased total body sodium, reduced sodium oral rehydration fluid (e.g. ReSoMal) should be used.* Vomiting is common and is not a contraindication to ORF; a nasogastric tube may be required. Back  *Pocket book of hospital care for childrenPocket book of hospital care for children

34 Sodium distribution in severe acute malnutrition (SAM) The abnormal physiological processes in SAM markedly affect the distribution of sodium. This directly affects clinical management. Print-out the next slide showing a child with kwashiorkor Mark the boxes to show whether the sodium concentration is higher, unchanged or lower than normal Then compare your answers with the final slide A child with kwashiorkor

35 Question: Sodium distribution in severe acute malnutrition Mark the boxes to show whether the sodium concentration is higher, unchanged or lower than normal A child with kwashiorkor A. Plasma  Higher  Unchanged  Lower E. Total body sodium  Higher  Unchanged  Lower D. Extracellular fluid  Higher  Unchanged  Lower C. Intracellular fluid  Higher  Unchanged  Lower B. Urine  Higher  Unchanged  Lower

36 Answer: Sodium distribution in severe acute malnutrition A. Plasma: Low and may be very low B. Urine: Low due to impaired renal excretion of sodium C. Intracellular fluid: High due to failure of the sodium pump and leakage of sodium into cells D. Extracellular fluid: High – especially if there is nutritional oedema as in this child E. Total body sodium: High - the overall effect Also note that the diagnosis of dehydration in SAM is difficult and it is often overdiagnosed. Cardiac function is impaired in SAM. In view of these abnormalities, how should severe dehydration in SAM be managed? Write down your answer and then go to the next slide.

37 Answer: management of severe dehydration in SAM The increased total body sodium and impaired cardiac function in SAM explain why treatment with IV fluids can result in death from sodium overload and heart failure. IV fluids should be used only to treat shock in children with SAM who are also lethargic or have lost consciousness. The correct management is reduced sodium oral rehydration fluid (ORF, e.g. ReSoMal) given by mouth, using a naso-gastric tube if necessary The volume and rate of ORF are less for malnourished than well-nourished children* Next *Pocket book of hospital care for children.

38 Scenario: an unexpected finding from a simple audit A nurse working on a paediatric unit did a simple clinical audit of the last 20 children admitted with diarrhoea and severe dehydration. He was surprised to find that 6 of the children had died even though all had been treated with IV fluids. He noted that 7 of the 20 children had either visible severe wasting and/or bilateral pedal oedema and that 5 of the deaths had occurred in these children. He comes to you to help him to understand what is going on. Write down 3 things that you know about the pathophysiology of severe malnutrition that may explain these excess deaths. Markedly prolonged skin pinch in a severely malnourished child with diarrhoea

39 3 features of children with severe acute malnutrition: i.The diagnosis of dehydration based on clinical signs is difficult in SAM. Dehydration if often overdiagnosed. ii.Total body sodium is often increased in SAM. This is due to several mechanisms including: –Increased intracellular sodium; in the “sick cell syndrome” in malnutrition the cellular anion exchange pumps fail and sodium leaks into cells –Additional sodium in extracellular fluid if there is nutritional oedema –Reduced renal excretion of sodium Despite the increased total body sodium, serum sodium is often low or very low in children with severe malnutrition iii. Cardiac function is compromised in SAM. This underlying pathophysiology explains why severely malnourished children die from heart failure if they are given fluids too quickly or with too high a concentration of sodium. Scenario: excess deaths in severely dehydrated children with severe acute malnutrition (SAM) In view of this abnormal physiology in SAM, how would you advise the nurse to better manage severely malnourished children with severe dehydration?

40 You advise the nurse of the correct approach to management as follows: IV fluids should be avoided. A bolus of IV isotonic fluid is appropriate to treat shock, but severe dehydration should be managed with enteral fluids. The correct ORF to use is one with a reduced sodium and higher potassium content (e.g. ReSoMal; about 37.5 mmol Na + /l and 40 mmol K + /l). The WHO oral rehydration fluid is not appropriate as its sodium concentration is too high. The total volume and rate of administration of ORF is much less in malnourished than well nourished children.* Vomiting is common and is not a contraindication to ORF; a nasogastric tube may be required. Furthermore, you suggest that the nurse repeats his clinical audit after this change in management. You also ask him to arrange a meeting of a small multidisciplinary team (including a senior nurse from both the wards and emergency room and a pharmacist) to meet to review the results when available. Scenario: appropriate management of severely dehydrated in SAM Next *Pocket book of hospital care for children.

41 Example request to use material Re: Permission to use in an open-access, eLearning resource Dear Sir / Madam, I am developing an eLearning module about. The main target group(s) for this module is/are. The completed module will be placed on an educational internet site hosted by the Medical School, Swansea University, Swansea, UK. Please note that the module will be freely available and neither myself nor anyone at Swansea University will make any profit. I would be very grateful if you would give me permission to reproduce the item detailed above in the module. I confirm that I will acknowledge the source of the item and also your permission for its use in this way. With many thanks for considering this request and trust that you will be able to contribute to our efforts to improve health care delivery through providing freely-accessible education materials. Yours sincerely, Back


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