Evaluation of a massive open online course for just-in-time training in resource-limited settings: evidence from a COVID-19 course for healthcare workers (Preprint)

BACKGROUND The COVID-19 pandemic created an urgent global need for healthcare worker (HCW) training. Initial COVID-19-related online courses focused primarily on training public health workers and physicians caring for patients in intensive care units (ICUs). However, in resource-constrained settings, nurses and general practitioners are responsible for providing most COVID-19 patient medical care, typically lacking the training and equipment necessary to manage complex, critically ill patients. In these environments, early recognition and interventions to prevent patient deterioration are essential to optimizing outcomes. We developed a massive open online course (MOOC) for HCWs in resource-constrained settings aimed at training bedside providers caring for patients with COVID-19. OBJECTIVE This study evaluates the impact of this MOOC by assessing HCW course engagement, knowledge, confidence in caring for COVID-19 patients, and user experience. METHODS From May thru June of 2020, the course was rapidly developed by a team of physicians, educators, medical illustrators, and education technology staff, and was subsequently launched on two online platforms in July 2020. The approximately 4-hour course comprises 6 video-based modules with accompanying handouts. Student knowledge was assessed using pre- and post-module quizzes and a final exam, while demographics and user experience were evaluated by pre- and post-course surveys and data collected through the platforms. RESULTS From July 17th to September 24th, 30,859 students enrolled, 18,818 started, and 7,101 completed the course. Most participants worked in healthcare (86%) and resided in lower middle- (36%) or upper middle- (21%) income countries. Higher course completion rates were observed among learners who were from upper middle-income (aOR 1.152 [95% CI 1.019-1.303]) and lower middle-income countries (aOR 1.229 [95% CI 1.104-1.368]). Significant knowledge gains were observed from pre-module (mean 56% [SD 17%]) to post-module quizzes (80% [SD 15%], P<.001), and from pre-module quizzes to the final exam (78% [SD 17%], P<.001). After course completion, participants reported increased self-efficacy regarding the course objectives, with a 0.63 mean increase on a 4-point scale (95% CI [0.60,0.66]). Overall, there was high satisfaction with the course experience, with 93% of participants reporting they would recommend the course to others. CONCLUSIONS This study demonstrates the potential of MOOCs to rapidly provide access to emerging medical knowledge during a public health crisis, particularly for HCWs in high- and middle-income countries. Further research is required to understand the impact of such online courses on patient care and how to better reach learners in low-income countries.