ABSTRACT
Background: Countries in sub-Saharan Africa continue to face insufficient health education resources and facilities, as well as a severe shortage of health care professionals. In 2019, the Levy Mwanawasa Medical University (LMMU) in Lusaka was launched to address the shortage of healthcare professionals implementing a decentralized training model utilizing selected regional and district hospitals in Zambia as training sites for various cadres. Decentralization makes it more challenging to monitor the learning process as part of continuous assessment; consequently, adequate approaches are necessary to ensure the quality and quantity of medical skills training. Electronic logbooks (e-logbooks) provide a promising tool for monitoring and evaluation of the medical training process. Objective: We designed and implemented an e-logbook for Medical Licentiate students based on an existing software system. We evaluated the feasibility of this e-logbook, its acceptability among a cohort of Medical Licentiate students and their mentors, as well as its facilitators and barriers. Materials and methods: During the course of a five-week-long clinical rotation in a training site in Kabwe, Zambia, two mentors and ten students participated in the pilot study and its evaluation. A mixed-methods approach utilized log-based usage data from the e-logbook web platform and conducted semi-structured in-depth interviews. Results: Overall, both students and mentors accepted e-logbooks as a means to monitor skills development in this context, indicating that e-logbooks are a feasible tool in this decentralized setting. Feedback pointed out that the design and software-induced terminology of the e-logbook posed usability issues. The complexity and greater time commitment (mentors used a web-based platform instead of an app) limited the e-logbook's potential. Conclusion: We conclude that there is acceptability of monitoring medical skill development through a tablet-based e-logbook. However, the e-logbook in its current form (based on an existing software system, with limited adaptation possibilities to the local context) was insufficient for the LMMU environment. Given that this was attributable to design flaws rather than technology issues or rejection of the e-logbook as a quality assessment tool in and of itself, we propose that the e-logbook be implemented in a co-design approach to better reflect the needs of students and mentors.
ABSTRACT
BACKGROUND: e-Learning for health professionals in many low- and middle-income countries (LMICs) is still in its infancy, but with the advent of COVID-19, a significant expansion of digital learning has occurred. Asynchronous e-learning can be grouped into interactive (user-influenceable content) and noninteractive (static material) e-learning. Studies conducted in high-income countries suggest that interactive e-learning is more effective than noninteractive e-learning in increasing learner satisfaction and knowledge; however, there is a gap in our understanding of whether this also holds true in LMICs. OBJECTIVE: This study aims to validate the hypothesis above in a resource-constrained and real-life setting to understand e-learning quality and delivery by comparing interactive and noninteractive e-learning user satisfaction, usability, and knowledge gain in a new medical university in Zambia. METHODS: We conducted a web-based, mixed methods randomized controlled trial at the Levy Mwanawasa Medical University (LMMU) in Lusaka, Zambia, between April and July 2021. We recruited medical licentiate students (second, third, and fourth study years) via email. Participants were randomized to undergo asynchronous e-learning with an interactive or noninteractive module for chronic obstructive pulmonary disease and informally blinded to their group allocation. The interactive module included interactive interfaces, quizzes, and a virtual patient, whereas the noninteractive module consisted of PowerPoint slides. Both modules covered the same content scope. The primary outcome was learner satisfaction. The secondary outcomes were usability, short- and long-term knowledge gain, and barriers to e-learning. The mixed methods study followed an explanatory sequential design in which rating conferences delivered further insights into quantitative findings, which were evaluated through web-based questionnaires. RESULTS: Initially, 94 participants were enrolled in the study, of whom 41 (44%; 18 intervention participants and 23 control participants) remained in the study and were analyzed. There were no significant differences in satisfaction (intervention: median 33.5, first quartile 31.3, second quartile 35; control: median 33, first quartile 30, second quartile 37.5; P=.66), usability, or knowledge gain between the intervention and control groups. Challenges in accessing both e-learning modules led to many dropouts. Qualitative data suggested that the content of the interactive module was more challenging to access because of technical difficulties and individual factors (eg, limited experience with interactive e-learning). CONCLUSIONS: We did not observe an increase in user satisfaction with interactive e-learning. However, this finding may not be generalizable to other low-resource settings because the post hoc power was low, and the e-learning system at LMMU has not yet reached its full potential. Consequently, technical and individual barriers to accessing e-learning may have affected the results, mainly because the interactive module was considered more difficult to access and use. Nevertheless, qualitative data showed high motivation and interest in e-learning. Future studies should minimize technical barriers to e-learning to further evaluate interactive e-learning in LMICs.
