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Erica Frank, MD, MPH
Founder, President, and Executive Director, www.NextGenU.org
Professor and Canada Research Chair, UBC – Faculty of Medicine
NextGenU.org
the world’s first free university
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A distributed, computer-assisted, competency-based
mentored, and free model:
computer-based knowledge transfer, coupled with
peer and local mentored experiences.
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The first problem we’re helping fix:
democratizing health sciences learning
• In 2006 WHO identified a need for 4.3million more trained health workers globally
• WHO also said that this will require greater use of training innovation, especially throughinformation and communication technologies
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Founding Collaborators and Funders
American College of Preventive Medicine
Annenberg Physician Training Program
Centers for Disease Control and Prevention
NATO – Science for Peace
University of British Columbia
World Bank
World Health Organization
World Medical Association
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How are we free?
• Cost-free
• Barrier-free
• Ad-free• Carbon-free
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eDATA K Computer-Based Drug and Alcohol Treatment
Assessment in Kenya
UBC
Africa Mental Health FoundationOthers
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Main components
Training – NextGenU.org – KAP and training performance
Randomized control trial – Alcohol, tobacco, SUD:
Results of screening VS Brief Intervention
Independent assessment of consumption, Follow-upforms, quality of life, stigma
Developmental Evaluation
Including the learning as it goes – modifying the intervention andresearch methodology
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Settings
2 districts
One intervention “as is”
Other with practice support training
for the management team and leaders, to facilitateimplementing and maintaining the intervention
Public health care centers (4)
Private clinics (4) under a capitation modelserving middle income Kenyans
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TrainingOffered to all who want to take it - Specific targets
Screening using the Assistlay health workers
Dx, Tx, Referral – mhGAP
Nurses, Medical Officers, General Practionners, MD
Fellowship in Addiction Medicine – ASAM (Tobacco, Alcohol)
Mentors
Practice Change (NHS Leadership Academy, Canadian Health Leaders, AccreditationCouncil for Graduate Medical Education – Common Competencies)
Managers – Clinical Leaders
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Activities So Far 1.1:Engage and mobilize stakeholders
Sub-grant, Hiring, MoU, Advisors, Ethics
1.2: Select and adapt the learning materials and
evaluation methods – in progress
1.3: Pilot test and refine the training with 20 traineesand 10 mentors- April
2.1: Evaluation study preparation
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Activities to come
Finish building and adapting the trainings
Pilot test the trainings
Train all the targeted stakeholders
Put the research infrastructure in place
Conduct the RCT and developmental evaluation
Analyze and disseminate the results
Improve and scale the trainings
Improve and scale the provision of SUD services in primary care in Kenya
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2012-2013 Clinical Public Health and Prevention Trainings
= All core public health areas [Epidemiology, Biostatistics, Health Policy/Mgmt, Environmental Health, HealEducation, co-sponsored by the American Association of Public Health Physicians and the Association fo
Prevention Teaching and Research]
= Adolescent Health [American College of Preventive Medicine, UBC]
= Adult and Pediatric Cardiovascular Disease Prevention [Emory University, Latin American PediatricAssociation, Universidad San Francisco de Quito]
= Climate Change and Health [350.org, David Suzuki Foundation, Health Care Without Harm, InternationalSociety of Doctors for the Environment, Physicians for Social Responsibility, UBC]
= Physical Activity and Health [American College of Sports Medicine, Fundacion Sante Fe, U.S. Centers forDisease Control and Prevention]
= Preventive Medicine [American Association of Public Health Physicians, Public Health Foundation of Indand the Association for Prevention Teaching and Research]
= Prevention/Treatment of Alcohol Use Disorders [Annenberg Physician Training Program, UBC, UF]
= Prevention and Treatment of Tobacco Use [International Federation of Medical Student Associations,International Primary Care Respiratory Group]
= Trade and Health [Center for Policy Analysis on Trade and Health]
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2012-2013 Clinical Trainings
= Emergency Medicine [Emory University, Society for Academic Emergency Medicine, International Federationfor Emergency Medicine]
= Family Medicine [MoH Sudan, U of Gezira, WONCA]
= Gynecology/Obstetrics and Perinatal Care [International Federation of Gynecologists and Obstetricians, LatinAmerican Pediatric Association, Medical Women’s International Association]
= Occupational/ Physical Therapy [Rocky Mountain University of the Health Sciences, Kenyan Physical TherapyAssociation]
= Pathology [UBC Department of Pathology]
= Pediatrics [Latin American Pediatric Association]
= Preventive Medicine [American Association of Public Health Physicians, American College of PreventiveMedicine, Association for Prevention Teaching and Research, USF Quito]
=Psychiatry [AMHF, Annenberg Foundation, UBC, U of Florida] = Surgery (Orthopedic) [Presbyterian University of East Africa, College of Surgeons in East, Central and
Southern Africa]
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2012-2013 Basic Science Trainings
= Anatomy: Dental
= Clinical/PH Genetics
= Immunology
= Physiology (cardiophysiology)
= Pre-health professionals certificate (biology, math, medical humanities,organic chemistry, physical chemistry, physics)
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1. Identify expert driven
competencies 2. Populate course curriculum using free,comprehensive, easily accessed, high
quality, authoritative resources
3. Specify learning objectives f
each resource
4. Develop evaluation and interactive activities
MCQPeer-to-peer
Mentored activities
Discussion forum
Instantly translated chat
room
5. Course-specificAdvisory Committee toreview course material
6. Integrate learner
feedback
NextGenU.org Course Development Process
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Matching existing competencies with existing resour
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64 Languages Available
• Afrikaans
• Albanian
• Arabic
• Azerbaijani
• Basque
• Belarussian
• Bulgarian
• Catalan
• Chinese (Tr)
• Chinese (Si)
• Croatian• Czech
• Danish
• Dutch
• Italian
• Japanese
• Korean
• Latin
• Latvian
•Lithuanian
• Macedonian
• Malay
• Maltese
• Norwegian
• Persian• Polish
• Portuguese
• Romanian
• English
• Estonian• Filipino• Finnish• French• Galician
• Georgian• German• Greek • Haitian Creole• Hebrew
• Hindi• Hungarian• Icelandic• Indonesian• Irish
• Russian
• Serbian• Slovak
• Slovenian
• Spanish
• Swahili
• Swedish
• Thai
• Turkish
• Ukrainian
• Urdu• Vietnamese
• Welsh
• Yiddish
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Interactive Activities Feedback Opportunities
Peer MCQs / cases Feedback form for each resource
Mentored activities Peer feedback for posted assignments
Discussion forums Guided & free text feedback in forums
Instantly translated chat rooms Course evaluations
Word Games: Crossword, Cryptex,
NextGenU.org version of “hangman”
Live technical support
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Mentored Activities
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Mentored Activities
•Review with your supervisor how to take a focused history appropriate to ED complaints.
•Review all your management plans with your supervisor.
•Review with your supervisor the role of your ED in your community and access to care.
•Review with your supervisor the costs of tests in your hospital.
• Review with your supervisor normal and abnormal glucose levels for your institution.
•Perform IV insertions under supervision.
•Perform phlebotomies under supervision.
•Watch any central lines performed by your supervisor.
•Perform bag-mask ventilation under supervision until comfortable ventilating a patient.
•Learn how to operate the defibrillator available to your institution from your supervisor.
•Have your supervisor demonstrate NG tube insertion with you.
•Have your supervisor review and demonstrate catheterization with you.
•Have your supervisor review and demonstrate casting/splinting principles with you.
•Have your supervisor review and demonstrate technique for incision and drainage.
•Have your supervisor demonstrate proper C-spine immobilization.
•Review the procedure with your supervisor if ultrasound is available at your institution.
•Perform local anesthetic infiltration under supervision.
•Review suturing technique with your supervisor.
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Competency 3 1 Effectively communicate with patients family members and other
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Competency 3.1 - Effectively communicate with patients, family members, and other
members of the health care team.
Meet with a health care professional, other than a physician, who works in the emergency
department (such as a nurse, respiratory therapist, or social worker). Discuss with themwhat their role is in the emergency department, and gain a brief understanding of their
training. Write a short essay (250-500 words) on the role of this health care provider, and
how their role helps you in managing your patients.
Evaluation criteria:
1. 250-500 words
2. Clearly outline the role of another health care professional (other than physician) in the
ED
3. Describe how the role of this health care provider is important in the care of emergency
patients
4. Describe how the role of this health care provider helps you in managing your patients
Case #1
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A 15 year old female presents to the ED with a ruptured ectopic pregnancy. The gynecologist
wants to take the patient to the operating room and requires consent for the procedure. The
patient’s mother is in the waiting room. You have deemed that the patient is competent, and
understands the risks and benefits of the procedure. The patient has asked that you do not tell h
mother about the pregnancy.
Is this patient eligible to give her own consent at age 15? Would you tell the patient’s mother a
her condition? Write a short essay (300-500 words) justifying your decision, using ethical and
legal principles. Briefly outline the laws for age of consent in your country.
Evaluation criteria:
1. 300-500 words
2. Outline the law regarding age of consent in your country
3. Attempt to justify your decision to either tell or not tell the patient’s mother about her conditi
4. Identify at least 2 ethical issues surrounding your decision-making process
Case #2
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A 35 male presents to your ED with fever, malaise, and cough. He tells you that he
has recently been diagnosed with HIV. You suspect that he has pneumocystis
jiroveci pneumonia. His wife is in the waiting room, and the patient tells you that
she does not know of his HIV diagnosis, and asks that you do not tell her. They are
currently sexually active.
Would you tell his wife about her husband’s HIV status, despite the fact that he
asked you not to, in order to protect his wife? Are you obligated to report his
disease to the local health authorities? Write a short essay (300-500 words) about
your decision making process, and justify your decision using ethical and legal
principles.
Evaluation criteria:
1. 300-500 words
2. Outline the law in your country regarding HIV reporting3. Identify at least 2 ethical issues surrounding this case
4. Attempt to justify your decision using ethical principles
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Assessment Security
Students can be video-recorded
Students’ computers’ cut and paste functions can be frozen
Sites accessed during exam-taking can be tracked
Examinations can be printed and administeredlocally under direct supervision
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Research Metrics
• Name• Email
• Prior degrees
• Current training• Location
• Institution
• Job title• NextGenU metrics
Registered Emergency Medicine Students – 41 Countries
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Afghanistan Ethiopia Pakistan
Argentina Georgia Peru
Australia Germany Singapore
Barbados Great Britain South Africa
Brazil Hong Kong Sri Lanka
Bulgaria India Sweden
Canada Indonesia Switzerland
Columbia Ireland Syria
Czech Republic Italy Thailand
Denmark Jordan Turkey
Ecuador Kenya Uganda
El Salvador Mexico United Arab Emirates
Netherlands United States
Nigeria Venezuela
Zimbabwe
g g y
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Average for Quizzes 86%
Final Exam 1 72/75 96%
Cumulative 188/210 89.52%
Student 2: Sample data for Quizzes and Final Exam
Final Exam Sampling
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Fullname # of Attempts Marks Percentage Last attempted on Student1 1 59/75 78.7% April 26, 2012, 6:17 am
Student2 1 75/75 100% April 26, 2012, 6:35 am Student3 1 72/75 96% April 26, 2012, 6:44 am
Student4 1 68/75 90.7% April 26, 2012, 7:25 am
Student5 1 72/75 96% April 26, 2012, 7:34 am
Student6 1 71/75 94.7% April 26, 2012, 7:39 am
Student7 1 69/75 92% April 26, 2012, 7:34 am
Student8 1 68/75 90.7% April 26, 2012, 7:42 am
Student9 1 66/75 88% April 26, 2012, 8:11 am
Student10 1 74/75 98.7% April 26, 2012, 8:07 am
Student11 1 69/75 92% May 4, 2012, 11:49 am
Cumulative 763/825 92.48%
Final Exam Sampling
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Quiz: Competency 6.1. Understand the approach to the approach to abdominal pain 10
66.66% 1
100.00% 9
Quiz: Competency 6.2. Understand the approach to altered mental status 10
66.66% 5
100.00% 5
Quiz: Competency 6.3. Understand the approach to cardiac arrest 10
66.66% 2
100.00% 8
Quiz: Competency 6.4. Understand the approach to chest pain
10
100.00% 10
Quiz: Competency 6.5. Understand the approach to gastrointestinal bleeding 10
66.66% 2
100.00% 8
Quiz: Competency 6.6. Understand the approach to headache 10
66.66% 1
100.00% 9
Quiz: Competency 6.7. Understand the approach to poisoning 10
33.33% 1
66.66% 3
100.00% 6
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A distributed, computer-assisted, competency-based,mentored, and free model:
computer-based knowledge transfer, coupled with pe
and local mentored experiences.
N tG U h ith th MOOC
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NextGenU shares with other MOOCs…
The knowledge that we:
• aim to help democratize learning;
• are not a panacea and will not replace many universityfunctions;
• rely heavily on the largesse of traditional universities,standing on the shoulders of generous giants who have
provided the learning resources, platforms, time, funding,and on- and off-line teaching precedents and inspirations;
• need to nurture each other as we learn how best to usethese powerful tools for massive good;
• will continue to improve by open-mindedly incorporatingothers’ innovations and generously sharing our own;
• have a long way to go to achieve educational nirvana, buthave an unprecedented opportunity for locally-deliverededucation everywhere, all the way to post-graduateeducation, and therefore an unprecedented obligation.
H N tG U diff f th MOOC
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How NextGenU differs from other MOOC
1. Credit
2. Free
3. Financial sustainability
4. Best available resources
5. Higher-level education
6. Competency-based foundation
7. Language
8. Extensive human interactions
9. Interactive computerized learning
10.Extensive computerized and human assessment
11.Completely open use
12.Active partnerships with multiple experts and with end users
13.Customizability
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“NextGenU is a visionary undertaking.” – Jeffrey P. Koplan, MD, MPH, Former
Director, U.S. CDC
“ NextGenU.org will help globally democratize health science knowledge.” -
Carmen Carpio, Knowledge Management Officer, World Bank
“NextGenU is an incredible resource for health professionals all over the world.
Open access to health information should literally save millions of lives and
lead to important new discoveries.” -Anne Margulies, former Executive Director,
Open Course Ware, MIT
“NextGenU is expected to make a considerable contribution to the advancement
of e-learning worldwide.” -WHO, Building Foundations for E-Health, 2006
“The internet at its finest… a bonanza… a boon… an incredibly worthwhile
enterprise… a model of what Health 2.0 and Science 2.0 can be… one of the
most altruistic and honorable health service resources on the planet.” -Online
reviews
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Ways to Engage
Advisors
Course creators
Organizational collaborators
End-product users
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Erica Frank, MD, MPH
[email protected], [email protected]
Founder and Executive Director, NextGenU.org
Professor & Canada Research Chair, University of British Columbia