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Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model

机译：尼泊尔农村向主动学习的过渡：一种适应性强且可扩展的课程开发模型

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Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning. The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted. Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3–6, maintained at 31% through months 6–12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3%?±?4.5%, p?=?0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site. We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.
机译：历史上，世界许多地方的传统医学教育都依赖于被动学习。尽管主动学习在医学教育文献中已有数十年的历史，但一直未将其纳入实践。我们描述并分析了尼泊尔农村地区医院多学科继续医学教育课程的实施情况，该课程的核心目标是朝着主动学习的组织转变。干预发生在尼泊尔偏远地区的一家地区医院，人员主要由中级医疗服务提供者提供。干预之前，教育课程包括传统的教学方法。我们进行了混合方法需求评估，以确定修订课程的内容和教育策略。我们的目标是开发有效，相关且可接受的课程，以促进积极学习。作为干预的一部分，医生通过创建和提供讲座来充当学习者和老师的角色。演讲者使用讲座模板来确定清晰度，相关性和观众参与度，包括讨论问题和临床案例。在研究期间完成了两个六个月的课程周期。每日讲座评估评估了理解，相关性，临床实践变更和参与的难易程度。定期的讲座审核记录了学习者的谈话时间，即学习者在谈话中所占的时间比例，作为主动学习的替代物。来自评估和审核结果的反馈被提供给演示者，并进行了课前和课后知识评估考试。讲座审核显示，学习者的谈话时间显着增加，从基线的14％增长到3-6个月的30％，到6-12个月保持在31％。讲座评估显示对课程的满意度。课前和课后知识评估得分从50％提高到64％（差异13.3％？±？4.5％，p？=？0.006）。作为衡量组织变革的结果，该课程在其他临床站点被复制。我们证明，可以通过实施新的教育策略来促进主动学习。讲座审核对内部计划的改进非常有用。干预措施的组成部分可以转移到其他农村地区，包括使用学习者作为教师，讲课模板以及提供即时反馈。该课程模型可以适应尼泊尔乃至全球的类似环境。

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