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