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Why are we developing Open Educational Resources for eye health training programmes?
- 1. Why are we developing OER for eye health training programmes? Sally Parsley, Daksha Patel, Astrid Leck, Jo Stroud LSHTM Education Day 22/09/2016 @sallyeparsley Improving health worldwide www.lshtm.ac.uk 1. Context 2. Our strategy 3. What we’re doing 4. Are we making a difference? 5. Lessons learnt/ opportunities
- 2. 285 million visually impaired people Epidemiology and visual impairment video from our Global Blindness OER. https://youtu.be/eRQnwOHU8Os
- 3. Cartogram showing the distribution of practicing ophthalmologists worldwide by country. Larger areas represent higher numbers and smaller areas proportionally smaller data values (from Bastawrous and Hennig, 2012) <1 ophthalmologist per million people in 23 countries
- 5. Health care worker screening in the community using Peek, a smartphone based diagnostic tool. KENYA. Credit: Peek CC BY-NC https://flic.kr/p/FpgdTW
- 6. Ophthalmic training in the hospital using a smartphone. Credit: Olufunmilola A. Ogun CC BY-NC https://flic.kr/p/DZSFZw
- 7. Claire Walker CC BY-NC flic.kr/p/9qUnCQ
- 8. Geralt CC BY-0 https://pixabay.com/en/open-neon-note-entry-light-70835/
- 9. MIT OpenCourseWare >2 million visits each month 3 US MOOC platforms >25 million enrolments 2012-2015
- 10. (de los Arcos et al. 2015) (Koller et al, 2015) (Manturuk K, Ruiz-Esparza QM, 2015) MOOC on students “Duke university instructors who had developed MOOCs changed their teaching approach in both MOOCs and traditional courses, including by improving classroom materials and activities, crafting better measures of student learning, and experimenting with new pedagogies to increase engagement and learning.”
- 11. Samuel Siminyu presenting study results at OER16 conference. Credit: Sally Parsley CC BY
- 12. % households with internet access by level of development, 2005-2014 (ITU, MIS Reports, 2014) World’s offline population 2016 >50% not using the internet
- 13. Adapted from: Nadia Mireles CC BY 3.0 sharingoer.com Open online course made up of OERs Our courses and curriculi CC - shared, adapted, re-used MOOC Our approach
- 14. Gap analysis to identify topicsSteve Jurvetson CC BY flic.kr/p/5u989W
- 15. Course development Example learning design
- 16. By 2019 • 7 courses on OpenStudy • Syndicated OER materials • 3 SSA partners localise & accredit courses (+more?) • Digital literacy training and empowerment for eye care educators
- 17. • 3,062 learners • 69% from LMICs 17 of 20 Global Blindness course 2014/15
- 18. 1 year survey: 4% response rate (n=139) 85% had applied learning to work 88% reported educational benefits 72% reported career benefits
- 19. Survey of learners 1 year later (n=139) 70% had used the OER for teaching and learning
- 20. UCT Vula and external versions of the Global Blindness OER https://youtu.be/eRQnwOHU8Os
- 21. Conclusions / lessons learnt • Substantial appetite for informal, online learning amongst eye care workers in LMICs. • Online, self-directed learning is likely to fully engage only the most enabled learners. • Eye care educators and training institutions are reusing the OER in various innovative ways in their local contexts. • Empowering wide uptake of the OER by eye care educators in local training programmes is crucial for sustainable success – issues to explore around awareness, access, capacity, skills and acceptability.
Notas do Editor
- Hi, thank you so much for being here. My name’s Sally Parsley, I’m based with the International Centre for Eye Health in ITD and I’m the technical lead on the project I’m going to talk about today. I’m going to start by talking about the context for the project – the issue of global visual impairment and the global gap in ophthalmic human resources and training. And also about OER, what they are, and a little bit about how their use impacts teaching and learning. Then I’ll go onto explain our strategy for using OER to support eye health training programmes, what we’ve done so far, what we plan to do and what the data we have collected so far indicates about whether our activities are making a difference. I’ll finish by sharing a few thoughts on the lessons we’ve learnt and the opportunities we see as we move forward.
- 1. Context There are 285 million visually impaired people globally. 80% of this visual impairment could be treated or prevented. 90% of visually impaired people live in LMICs (Pascolini & Mariotti, 2012) An international WHO programme “Universal Eye health: A Global Action Plan” (WHO, 2013) aims to address this issue by: Delivering targeted action on specific disease such as cataract, diabetes etc. Strengthening eye health systems Advocating for investment in eye care
- However, lack of human resources and limited training in global eye care are key constraints for the delivery of this programme. We have 200,000 ophthalmologists globally but 23 countries have less than 1 ophthalmologist per million population (Resnikoff et al, 2012). SSA in particular faces an alarming shortage of eye care workers and does not have enough specialised eye care training facilities
- – as shown on this table there is 1 specialist eyecare training facility for 5,800,000 people in Anglophone SSA and the situation is even worse in Francophone Africa (IAPB, 2014).
- A team approach to service delivery has been identified as the efficient management option for eye care provision (Resnikoff et al, 2012). Screening is done in remote settings and a referral network is established to provide surgical and medical care.
- Traditionally, ophthalmic training is provided through an “apprentice” type format where students learn directly through practice in clinics and surgery. Senior clinicians double up as lecturers and pass on their skills and knowledge.
- Training teams is ad hoc in many places or through short workshops. It is mostly dependant on availability of funding, with external trainers often from the NGO sector. We do have an international ophthalmic curriculum (Tso et al, 2007) which sets the global standards in eye care education around the world. Public health approaches are embedded in the curriculum but they remain the most difficult to teach to clinicians – mostly due to lack of trainers.
- So now I’m going to talk a little bit about Open Educational Resources. OER are educational materials which are free to keep, use, adapt and share without requesting permission from the copyright holder (OECD 2007, p. 10). OERs on the internet can reach greater number of people which can increase their impact on students learning and increase innovation and improvements in educators’ practice. (Patel and Parsley, 2015) MOOCs or massive open online courses are characterised by unrestricted participation, minimal teaching supervision, and free or low cost access. MOOCs become OER when they are free to access and are openly licensed.
- Both OER and MOOCs have significant numbers of online users. One of the largest OER collections, MIT’s OpenCourseWare website receives over 2 million visits each month. (MIT OpenCourseWare. Site statistics). The 3 big US MOOC platforms had more than 25 million enrolments between 2012 and 2015 (Kanwar and Mishra, 2015).
- Several recent studies have indicated that OER and MOOC use has positive impacts for educators’ practice and brought learners satisfaction and post course career and educational benefits. The OER Research Hub survey of 7,500 OER users found that 56% of teachers felt they now had a more up-to-date knowledge of their subject area and just over 60% of learners reported that OER positively impacted their levels of interest and satisfaction with their studies. (de los Arcos et al. 2015). A 2015 study of 50,000 Coursera learners (Koller et al, 2015) found that 87% of learners reported career-related benefits and 88% reported educational benefits. At Duke University, 30 educators involved in developing and delivering MOOCs reported changing their teaching approach in both MOOCs and traditional courses, including improving classroom materials and activities and experimenting with new pedagogies (Manturuk K, Ruiz-Esparza QM, 2015). Most MOOC participants are well educated - 70% have a first degree (Mcleod et al, 2015). Educators have criticised MOOCs for inequitable access, low completion rates, outdated teaching methods and for corporatising education (Laurillard, 2014), (Online course report, 2016).
- There is limited data on use and impact of OER and MOOCs in LMICs (Cheryl Hodgkinson-Williams, ROER4D team. 2014). A really interesting recent study of OER uptake amongst university students and faculty in Uganda found that: Good awareness of OER, frequent engagement with it and a strong motivation to use it were among the key enablers. Uptake was hindered by a missing culture of openness in institutional policies and practices, poor ICT infrastructure, lack of digital skills, and lack of clarity on copyright issues (Siminyu & Wells, 2016).
- Internet access, especially via mobile devices continues to grow strongly around the world. It’s important to remember that internet access remains deeply divided. Half the world’s population remains offline and the relative price of bandwidth is higher and absolute speeds are lower in LMICs. (ITU, 2016).
- At ICEH we have extensive experience in providing PHEC training and in publishing OER for low bandwidth settings. And when we looked at the evidence I’ve outlined above together we felt that OERs in the form of open online courses – such as MOOCs – could be an innovative way for us to provide – in the first instance - informal learning opportunities in PHEC to eye care workers in LMICs who had the access and the capacity to benefit from self-directed online learning but would otherwise be unlikely to have access to such training. And, by enabling local eye care training programmes and individual faculty to adapt and repurpose the OER materials and courses for their own contexts, we could do so in a sustainable way and contribute to addressing the global ophthalmic training gap in support of the Global Action Plan. 2 funders are providing crucial support for the programme - SiB and the Queen Elizabeth Diamond Jubilee Trust. Each course costs between £50,000 to £100,000 to develop.
- We used a gap analysis to identified key PHEC topics to develop into courses: Planning and managing eye care services – cataract and refractive error An introduction to epidemiology for eye care Assessing and using evidence in eye care practice 4 disease specific courses in trachoma, DR, ROP and glaucoma.
- We have key guidelines when developing courses: We create a detailed learning design with clear course objectives and learning outcomes tied to OERs and learner activities Encourage active learning by participants through reflection, discussion and quizzes Use visual content to overcome cultural and language difficulties Use examples from LMIC settings Engage many experts from LMIC settings Ensure the material is as accessible as we can make it to low bandwidth settings
- So far we have piloted our first 2 courses on LSHTM Open Study and delivered the Global Blindness course twice as a MOOC on Futurelearn. Eliminating Trachoma will be our next course, launching on Futurelearn on October 3rd By the end of 2019 we aim to have 7 courses available on Open Study for self–directed learning and to have the materials syndicated across popular online platforms (like YouTube) for easy access by educators. We are also working with 3 SSA eye care training partners – supporting them to adapt and accredit the GB course for their local context. And we are developing a digital literacy OER and a series of webinars on technology enhanced teaching and OER specifically aimed eye care educators.
- Are we making a difference? It is early days but we think we have some encouraging evidence from the Global Blindness course on: who we reached, participation, application of learning, benefits of study and use of the materials. Participation (over pilot and 2 runs of the course on FL) 5,323 registered, 3,062 participated 500 people completed course (15%). Cost per completion of ~£100. 1,061 people completed >50% First online course for most (69%) (n=1,473). 53% women 69% from LMICs, 44% from Sub-Saharan Africa (n=1,495) 83% health/social care workers (n=1,233) 96% satisfied or very satisfied with course experience (n=239) 307 certificates (8% of FL learners bought one. 2nd highest % after Ebola)
- Application of learning We found several individual examples of application of learning from the 6mth post course pilot interviews we carried out And a survey 1 year later: 4% response rate (n=139) found that 85% (118) had applied their learning to work. In addition, the majority of survey respondents reported experiencing course benefits 123 (88%) reported educational benefits 100 (72%) reported career benefits
- Uptake The 1 year survey found that 97 (70%) respondents had used course materials for teaching and learning And again we found a variety of innovative individual examples of use of the materials from the 6mth post course pilot interviews and a web form.
- Institutional uptake: UCT, South Africa, has just launched 2 localised versions of the course for standalone study by MSc CEH students and ophthalmology registrars.
- Conclusions / Lessons learnt Substantial appetite for informal PHEC online learningamongst eye care workers in LMICs. Eye care educators and training institutions are reusing the OER in various innovative ways in their local contexts. Online and self-directed learning is likely to reach only the most enabled learners. Access remains an issue - 86% preferred to download low-bandwidth OER in pilot (n=53) – The extent to which the project will be able empower further use of the OER amongst eye care faculty is a very interesting question – issues to explore around awareness, access, capacity and skills and acceptability. References Allen IE and Seaman J. (2016) Opening the Textbook: Educational Resources in U.S. Higher Education, 2015-16. Babson Survey Research Group. http://www.onlinelearningsurvey.com/reports/openingthetextbook2016.pdf Bastawrous A, Hennig BD. (2012) The global inverse care law: a distorted map of blindness. Letter. 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