A MOOC as an immediate strategy to train health personnel in the cholera outbreak in Mexico

Magaña-Valladares et al. BMC Medical Education (2018) 18:111 https://doi.org/10.1186/s12909-018-1215-1 RESEARCH ARTICLE Open Access A MOOC as an immediate strategy to train health personnel in the cholera outbreak in Mexico Laura Magaña-Valladares1* , Cynthia Rosas-Magallanes2, Alejandra Montoya-Rodríguez2, Guillermo Calvillo-Jacobo2, Celia Mercedes Alpuche-Arande3 and Sebastían García-Saisó4 Abstract Background: In September 2013, two cases of cholera were reported in Mexico; 1 week later, a new outbreak was reported in the Huasteca region of Hidalgo. Upon the determination that the diagnostic and therapeutic interventions implemented by health personnel overlooked predefined procedures, the National Institute of Public Health, in coordination with the Ministry of Health, immediately designed the massive open online course “Proper cholera containment and management measures” to strengthen and standardize basic prevention and control practices. Methods: During the first 5 months, 35,968 participants from across the country finished the course: medical and nursing personnel, health promoters, and hospital staff. To understand the magnitude of the data, an analysis was performed to calculate the MOOC coverage, and multiple linear regression models were generated to relate the score earned in the course to the characteristics of the participants. In addition, a qualitative analysis was performed to identify the dissemination of information, technological barriers, and feedback on course design. A total of 17% of participants were from the state where the outbreak originated, and 33.5% were from its neighboring states. Results: This study shows that the need for information is greater when an emergency occurs, and the involvement of the authorities increased the extent of the training response. Conclusion: A MOOC can be a useful training strategy to prepare personnel for emergency situations. Keywords: MOOC, Cholera, Epidemiological emergency, Health training Background In September 2013, the National Epidemiological Surveillance System reported two cases of cholera in Mexico City classified in the same serogroup, which were different from those circulating in the country, with strains similar to those found in Haiti, Dominican Republic, and Cuba. One week later, four new cases were identified, and later that year, a total of 175 cases were confirmed in the Huasteca region of Hidalgo, inhabited mainly by Otomi indigenous people [1], located approximately 121 km from Mexico City. * Correspondence: 1 Association of Schools and Programs of Public Health (ASPPH), 1900 M Street NW, Suite 710, Washington DC 20036, USA Full list of author information is available at the end of the article The need for rapidly training health personnel emerged after the determination that the diagnostic and therapeutic interventions implemented by the health personnel differed significantly in similar patient cases. A team of epidemiological surveillance experts from the Ministry of Health made a diagnosis about the care services of health professionals in the region and detected that some health personnel ignored prescribed procedures in both diagnosis and treatment and, in some cases, introduced errors in both aspects. Therefore, immediately implementing a massive process of strengthening, updating, and standardization of knowledge and basic practices of disease prevention, control, and treatment was considered necessary. Faced with this challenge, the Ministry of Health assembled a committee of experts from renowned health, social security, nutrition, © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Magaña-Valladares et al. BMC Medical Education (2018) 18:111 epidemiology, prevention, disease control, and technology development institutions to design and conduct the massive open online course (MOOC) titled “Proper cholera containment and management measures”. It was decided to create a MOOC because it was the most efficient way to reach as many people as possible in a small period of time despite the low rates of terminal efficiency that the evidence presents in regard to these courses [2]. The design of the MOOC was founded on the competency-based educational model of the National Institute of Public Health (INSP in Spanish) and was launched for all healthcare professionals of Mexico from different sectors. The Ministry of Health (SSA in Spanish) sent official letters to its state heads of education for to urge the entire healthcare workforce to complete the course as soon as possible. MOOCs are a valuable tool to distribute educational content through the Internet [3], with unlimited and open registration, and grounded in the theory of connectivism. This approach, developed by George Siemens, differs from behaviorism, cognitivism, and constructivism by fostering a close link between learning and Information and Communications Technology (ICT) [4]. The significant volume of participants that are gathered, the broad geographic reach, and the low unit cost are some of the positive attributes of MOOCs. Furthermore, MOOCs are designed under self-management systems, which enhance student interaction with content and automate learning activities. The present article addresses the experience of designing and conducting the MOOC “Proper cholera containment and management measures” with the objective of analyzing the coverage, function, and feedback on the design of the course and key factors for its effectiveness to confront an emergency situation. This strengthens the studies that have been carried out on education in a state of emergency, which refers to quality learning opportunities in crisis situations, including public health emergencies [5–7]. Methods The MOOC, an educational format chosen for its ability to reach across the country and being self-directed, had the following four main topics: a) the concept of cholera and prevention procedures, b) diagnosis, c) treatment, and d) key aspects to conduct a timely epidemiological surveillance. The MOOC was developed by a transdisciplinary group of academics and health officials who determined the competencies that health personnel require to adequately confront the cholera outbreak. A team of instructional designers created the learning activities based on the principles of andragogy [8], particularly Page 2 of 7 meaningful and practical knowledge acquisition, and following the learn (...truncated)