Continuing professional education for general practitioners on chronic obstructive pulmonary disease: feasibility of a blended learning approach in Bangladesh

Research article Open Access Published: 28 September 2020 Continuing professional education for general practitioners on chronic obstructive pulmonary disease: feasibility of a blended learning approach in Bangladesh Md. Nazim Uzzaman1,2, Tracy Jackson2, Aftab Uddin1, Neneh Rowa-Dewar3, Mohammod Jobayer Chisti1, G M Monsur Habib2,4, Hilary Pinnock  ORCID: orcid.org/0000-0002-5976-83862 & RESPIRE Collaborators BMC Family Practice volume 21, Article number: 203 (2020) Cite this article 245 Accesses 1 Altmetric Metrics details Abstract Background Continuing medical education (CME) is essential to developing and maintaining high quality primary care. Traditionally, CME is delivered face-to-face, but due to geographical distances, and pressure of work in Bangladesh, general practitioners (GPs) are unable to relocate for several days to attend training. Using chronic obstructive pulmonary disease (COPD) as an exemplar, we aimed to assess the feasibility of blended learning (combination of face-to-face and online) for GPs, and explore trainees’ and trainers’ perspectives towards the blended learning approach. Methods We used a mixed-methods design. We trained 49 GPs in two groups via blended (n = 25) and traditional face-to-face approach (n = 24) and assessed their post-course knowledge and skills. The COPD Physician Practice Assessment Questionnaire (COPD-PPAQ) was administered before and one-month post-course. Verbatim transcriptions of focus group discussions with 18 course attendees and interviews with three course trainers were translated into English and analysed thematically. Results Forty GPs completed the course (Blended: 19; Traditional: 21). The knowledge and skills post course, and the improvement in self-reported adherence to COPD guidelines was similar in both groups. Most participants preferred blended learning as it was more convenient than taking time out of their busy work life, and for many the online learning optimised the benefits of the subsequent face-to-face sessions. Suggested improvements included online interactivity with tutors, improved user friendliness of the e-learning platform, and timing face-to-face classes over weekends to avoid time-out of practice. Conclusions Quality improvement requires a multifaceted approach, but adequate knowledge and skills are core components. Blended learning is feasible and, with a few caveats, is an acceptable option to GPs in Bangladesh. This is timely, given that online learning with limited face-to-face contact is likely to become the norm in the on-going COVID-19 pandemic. Peer Review reports Background Provision of postgraduate training in Family Medicine is increasing in Asia Pacific, but rarely uses innovative online learning [1] that could enhance access to continuing medical education (CME) essential for building and maintaining a high-quality primary care workforce [2]. Traditionally in Bangladesh, post-graduate training involves face-to-face study, but shortage of physicians in many rural and semi-urban areas [3], mean that physicians often cannot leave their practices to attend several days of training. Blended learning is a combination of face-to-face and online learning [4], which has become possible in Bangladesh with recent substantial improvements in internet coverage, and may be a useful way to achieve CME [5]. Chronic obstructive pulmonary disease (COPD) is an exemplar of a condition in which there are concerns that limited awareness of guideline recommendations amongst general practitioners (GPs) [6, 7] leads to misdiagnosis and inappropriate management [8, 9]. COPD affects an estimated 251 million people worldwide [10] and globally, is predicted to be the third leading cause of death by 2030 [11]. Although COPD burden varies between countries, almost 90% of COPD deaths occur in low- and middle-income countries (LMICs) [10]. The national COPD guideline [12] is not widely used in Bangladesh. Some clinicians follow global guidelines [13], however, substantial gaps exist between guideline recommendations and GPs’ practice. Closing this gap is a priority research need for the International Primary Care Respiratory Group (IPCRG) [14]. Blended learning was introduced initially in undergraduate teaching [15,16,17,18] and is now extending to postgraduate learning [19], though the concept is relatively new in Bangladesh [20]. An online component allows practitioners increased time and flexibility for study, wider and easier access to learning resources, and a higher level of autonomy in learning than in exclusively face-to-face courses [21, 22]. Management of COPD requires acquisition of practical skills (spirometry; inhaler technique) necessitating a face-to-face component. Therefore, we aimed to assess the feasibility of a blended learning approach to a COPD CME course for GPs in Bangladesh. Methods Study design Our mixed-methods feasibility study was conducted in June to August 2019. Quantitative data measured pre-post self-assessment of adherence to COPD guidelines and qualitative focus groups and interviews explored trainee and trainers’ perspectives of the blended learning. Inclusion and exclusion criteria GPs providing public and private primary healthcare services in Bangladesh were invited to participate. GPs in Bangladesh have an MBBS (Bachelor of Medicine and Surgery) are registered by the Bangladesh Medical and Dental Council, have at least two years’ experience of clinical service but with no specialist post-graduate training. We excluded GPs who had previously participated in post-graduate COPD training at any time. Participant recruitment The COPD course, which was provided free of charge, was advertised nationally through the training management portal of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and social media was used to disseminate the course advertisement. Potential participants applied through the icddr,b portal. We screened applicants for eligibility, randomly selected 50 participants who were randomly allocated (using a computer generated randomisation list) to either blended learning or the traditional face-to-face course. Sample size This was a feasibility study, so no sample size calculation was required [23, 24]. Resource availability allowed us to run two courses, so we allocated 25 participants to each group. This is our normal group size, and is a sufficient sample size for assessing feasibility [25]. Study procedure The total training hours was 40 h in both blended and traditional learning approaches and the courses contained the same content: components aimed at enhancing COPD knowledge (16 h) and skills (24 h). A private Facebook group was created to provide online learning support for both groups monitored by a tutor and for peer discussion. The tutors were GPs with expertise in respiratory care and had considerable experience of delivering training. The learning approaches are sum (...truncated)