Introduction
Methods
Curriculum and e-Learning Development
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Step 1—Problem identification and needs assessment: Needs assessment was based on an online survey evaluating the safe handling practices in many different settings in LMICs and on audits the authors conducted in four African hospitals (unpublished data) [10].
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Step 2—Target audience: The e-learning module was principally aimed at healthcare professionals (physicians, nurses, pharmacists, pharmacy technicians) handling chemotherapies and working in low-resource settings. The module was developed in French to target French-speaking LMICs.
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Step 3—Goal and objectives: The module’s goal was to cover the main aspects of the safe handling of chemotherapies all along the chemotherapy pathway (e.g., receiving drugs, storage, transport, prescription, preparation, administration, waste management, and disposal), to ensure patient safety, and reduce the risks of occupational exposure and environmental contamination. The learning objectives for each lesson within the module were set using Bloom’s Revised Taxonomy [20]. Lesson content was based on best practice guidelines and recommendations, and all content was reviewed and validated by the steering committee members before being published online. We followed the principle of constructive alignment to ensure coherence between the learning objectives, content, and the evaluation [21].
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Step 4—Educational strategy: The lessons were developed so that they could be followed using an asynchronous, self-paced learning format, meaning that participants can access, start, interrupt, and restart the different lessons at any time that suits their professional and personal schedule. Each lesson lasted from 10–30 min. e-Learning lessons were developed using the Articulate Storyline 3 (Articulate Global inc.) authoring tool, which enables publication in the HTML5 markup language. The module is thus compatible with most devices, including tablets and smartphones. To keep the lessons engaging and interactive, there are many embedded questions and answers with instantaneous feedback. Graphics such as stick figures were obtained from PresenterMedia® (Eclipse Digital Imaging Inc). Video tutorials were also filmed to better teach good practices in chemotherapy preparation and were then uploaded onto the Pharm-Ed YouTube channel.
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Step 5—Implementation: The entire e-learning module was subsequently uploaded onto the Pharm-Ed platform (www.Pharm-Ed.net), a collaborative online educational platform for promoting the efficient, safe, and rational management of medicines in hospitals. Access to the platform is free, but registration is required to participate in the e-learning module. The LearnDash® learning management system—a WordPress plugin—was used to manage and track the learning process.
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Step 6—Evaluation and feedback: We based our evaluation on the first two levels of Kirkpatrick’s training program evaluation model, i.e., reaction and learning [22]. At the end of each lesson, an online satisfaction questionnaire evaluated participants’ reactions, with satisfaction measured on 5-point Likert scales for various aspects of the lesson (content, courseware, level of difficulty, and overall satisfaction). The last part of the questionnaire contained open-ended questions on the lesson’s perceived strengths and weaknesses. Participants’ knowledge was assessed before (pre-test) and after (post-test) each lesson. These tests came in the form of multiple-choice questions that were identical for each lesson and integrated into our learning management system. The multiple-choice questions were developed to match the lesson’s pedagogical objectives and content (constructive alignment). The differences between the pre-test and post-test scores were used to calculate participants’ learning gain in each lesson.
Conduct of the Study
Statistical Analysis
Results
Participants
No. of participants | No. of lessons | |
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Countries | ||
Algeria | 11 (13%) | 33 (12.7%) |
Belgium | 1 (1%) | 1 (0.4%) |
Benin | 1 (1%) | 2 (0.8%) |
Burkina Faso | 1 (1%) | 2 (0.8%) |
Cameroon | 3 (4%) | 15 (5.8%) |
Canada | 1 (1%) | 1 (0.4%) |
Cote d’Ivoire | 1 (1%) | 1 (0.4%) |
Democratic Republic of Congo | 3 (4%) | 4 (1.5%) |
France | 17 (21%) | 45 (17.4%) |
Gabon | 1 (1%) | 1 (0.4%) |
Greece | 1 (1%) | 2 (0.8%) |
Guinea | 1 (1%) | 2 (0.8%) |
Madagascar | 1 (1%) | 2 (0.8%) |
Mauritania | 1 (1%) | 2 (0.8%) |
Morocco | 10 (12%) | 40 (15.4%) |
Senegal | 20 (24%) | 90 (34.8%) |
Tunisia | 8 (10%) | 16 (6.2%) |
Profession | ||
Pharmacist | 56 (68%) | 179 (69.1%) |
Pharmacy student | 14 (17%) | 38 (14.7%) |
Pharmacy technician | 3 (4%) | 3 (1.2%) |
Nurse | 5 (6%) | 33 (12.7%) |
Physician | 1 (1%) | 1 (0.4%) |
Other | 1 (1%) | 1 (0.4%) |
Unknown | 2 (2%) | 4 (1.5%) |
Type of institution | ||
University teaching hospital | 19 (23%) | 62 (23.9%) |
Regional hospital | 4 (5%) | 15 (5.8%) |
District hospital | 4 (5%) | 19 (7.3%) |
Military hospital | 3 (4%) | 4 (1.5%) |
Private institution | 4 (5%) | 18 (6.9%) |
Student | 14 (17%) | 37 (14.3%) |
Other (NGO, health ministry, university) | 13 (16%) | 39 (15.1%) |
Unknown | 21 (26%) | 65 (25.1%) |
Total | 82 | 259 |