Distance Education And Learning: An Innovative Approach to Extending Workforce Training Capacity

Introduction

Funded in 2014 by the Health Resources and Services Administration (HRSA), the Region IV Public Health Training Center (R-IV PHTC) is 1 of 10 regional training centers that make up the national Public Health Learning Network. Included in the national network is the National Coordinating Center for Public Health Training and 40 local performance sites (LPSs) that work with their respective regional PHTCs to assess local training needs and provide marketing, outreach, education, training, and program evaluation. The mission of the national network is to improve the nation’s health system by strengthening the technical, scientific, managerial, and leadership competencies of the current and future public health workforce (HRSA, n.d.). Consistent with the national network’s mission, the R-IV PHTC seeks to build knowledge and skills in the public health workforce in the eight states that make up U.S. Department of Health and Human Services (HHS) Region IV (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and to develop and implement programming to train public health professionals using a variety of modalities, including distance-based education. The work of the R-IV PHTC is carried out by the Central Office located at the Rollins School of Public Health at Emory University and six LPSs (East Tennessee State University, Florida A&M University, Medical University of South Carolina, University of Alabama at Birmingham, University of Louisville, and University of North Carolina Wilmington).

The governmental public health workforce is vast and comprises a myriad of disciplines. Consistent with the R-IV PHTC’s mission, distance-based training is used to reach the broader workforce and affords many benefits to learners, including community building, instruction tailored to individual learner needs, flexibility, convenience, and the ability to access instruction anywhere and anytime (Cook et al., 2008; Liu et al., 2016; Moore, Perlow, Judge, & Koh, 2006; Wojciechowski & Palmer, 2005). An R-IV PHTC rapid needs assessment conducted in 2014 determined that the Central Office and all six LPSs had, at a minimum, a learning or event management system that could be used to support the provision of distance-based learning. Some sites had additional hardware and software resources (e.g., web conferencing or satellite broadcast systems) and/or institutional units designed to support distance-based training development and dissemination. The rapid assessment also found that many R-IV states had budgetary limitations that prevented personnel from traveling outside their local area for training. Thus, the growing need to provide distance-based training is clear; however, many experienced trainers lack the knowledge and skills necessary to adapt existing curricula to a distance format.

Distance Education And Learning (DEAL) is an online course designed by the R-IV PHTC to increase the capacity of public health trainers to teach in the distance environment. The development and implementation of the DEAL course is described here, including how it is used by the R-IV PHTC to increase the number of public health trainers who have the skills needed to develop and implement distance-based public health training and build training capacity within the region, thereby addressing issues of sustainability.

Background

Course Development and Design

The DEAL course was developed by a group of six individuals at the R-IV PHTC Central Office with experience in developing and/or implementing public health training in distance-based environments. The lead course instructor, who also serves as the director of the Rollins School of Public Health’s distance-based Master of Public Health program, has more than 15 years of experience teaching graduate public health education in a distance environment. Collectively, team members have more than seven decades of experience in traditional and distance-based training.

Course Description and Learning Objectives

Course Description

As society becomes more technologically advanced and funding constraints limit access to in-person trainings, educators need to reach a wider audience by offering trainings online with as much vigor and engagement as those offered face-to-face. The DEAL course is designed for experienced public health educators who are currently delivering in-person trainings and who want to adapt existing curricula for a distance-based audience. The competency-based course gives public health trainers tools and guidance to become effective educators in a distance-based environment, building on their skills as experienced instructors and providing opportunities for practice and discussion.

The DEAL course is divided into four 3-hour synchronous online modules with additional asynchronous presession and intersession activity requirements. The first three synchronous sessions are primarily didactic, with discussion and breakout group activities: (a) Designing Quality Distance-based Learning: Terminology, Standards, and Tools; (b) Teaching and Assessment Strategies; and (c) Beyond the Basics. (See Table 1 for a description and learning objectives for these three synchronous sessions.) The fourth synchronous session serves as the course capstone.

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Table 1.

Session Descriptions and Learning Objectives.

Session	Description	Session learning objectives
Session 1: Designing Quality Distance-based Learning: Terminology, Standards, and Tools	Session 1 will introduce participants to distance learning terminology, quality e-learning standards for the public health workforce and continuing professional education, and low-cost and free technology tools that can be used in e-learning. Participants will have an opportunity to explore some of the technology tools presented and learn about their potential uses, advantages and disadvantages.	Learning objectives: Upon completion of this session, participants will be able to
		1. Define distance learning terminology
		2. Describe e-learning standards for public health workforce continuing professional education
		3. Research technology tools for inclusion in distance-based instruction
		4. Assess personal learning style
		5. Critique distance-based trainings using e-learning standards
Session 2: Teaching and Assessment Strategies	Session 2 will introduce participants to teaching and assessment strategies used in distance learning environments. Working in small groups, participants will have an opportunity to identify teaching and assessment strategies for a variety of scenarios.	Learning objectives: Upon completion of this session, participants will be able to
		1. Identify distance-based teaching and assessment strategies for instruction
		2. Develop an instructional plan for a public health topic that includes
		• course description;
		• learning objectives; and
		• teaching and assessment strategies
Session 3: Beyond the Basics	Session 3 will introduce participants to advanced topics necessary for the implementation of distance-based instruction. Topics will include those related to the creation of instruction, marketing, and implementation of distance-based courses. Working in small groups, participants will have an opportunity to share their individual plans for instruction and get feedback from other training participants.	Learning objectives: Upon completion of this session, participants will be able to
		1. Discuss advanced concepts necessary for the implementation of distance-based instruction
		2. Use e-learning standards to provide feedback to others’ initial instructional plans
		3. Develop a training session related to a public health topic using e-learning standards

During the fourth synchronous session, participants deliver a 10-minute final presentation outlining a distance-based training they are planning to develop. Each capstone presentation provides an overview of the participant’s training and includes (a) intended audience, (b) description of training, (c) learning objectives, (d) teaching strategies, (e) assessment strategies, (f) technology(ies) to be used, and (g) challenges. Participants take part in one of the two capstone sessions offered.

Overall Course Learning Objectives

Upon completion of the DEAL course, participants will be able to

Discuss the use of e-Learning standards in distance education

Describe tools used in distance-based instruction

Critique distance-based trainings using e-learning standards

Incorporate distance-based teaching and assessment strategies to create a plan for instruction

Develop a plan for a distance-based training session related to a public health topic

Course Structure

The DEAL course uses both synchronous and asynchronous course delivery methodologies. In addition to four online synchronous sessions lasting 3 hours each, participants watch an asynchronous presession module prior to each synchronous session and complete additional intersession assignments. (See Figure 1 for a graphical representation of the course structure.)

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Figure 1.

Structure of the Distance Education And Learning (DEAL) course.

The synchronous sessions are facilitated using Adobe Connect and include both large group discussion and small breakout group activities. The presession modules are approximately 15 minutes in duration and were created using Adobe Captivate. The presession modules are intended to provide participants with an introduction to the content that will be further discussed during the synchronous sessions.

The course is hosted on the CourseSites by Blackboard learning management system. In addition to hosting course materials (course overview, session materials, intersession assignments) and discussion forums, the DEAL course site includes resources related to (a) sources for public health trainings, (b) curriculum basics, (c) creating distance learning courses, and (d) teaching and assessment strategies.

Preliminary Evaluation Results

The DEAL course was offered for the first time in spring 2016. Course participants were recruited from October 2015 to January 2016. Of the 20 individuals who applied, 14 were selected for participation and all 14 began the course. After the first synchronous session, one individual dropped out due to a conflicting schedule at work. Participants worked for organizations in Florida, Georgia, North Carolina, and Tennessee. Six of the 13 participants worked for governmental public health or tribal organizations at the federal, state, or local levels. Three worked for universities and the remaining four participants were consultants or worked with other public health agencies. Seven of the 13 participants reported that they had conducted trainings in a distance-based environment before participating in the DEAL course. Participants had an average of 8.3 years of public health training experience (range: 1-30 years).

Lessons Learned

The first offering of the DEAL course illustrated the importance of knowing the learners—both those experienced trainers who participated in the course and those members of the public health workforce who may be the recipients of distance-based learning. Individuals who participate in distance-based trainings must have access to the technology used, but they must also have supervisory support. It is also important to know the technological skills of the learners and have staff available to assist with technology-related questions. In the example of the DEAL course, in which Adobe Connect was used to deliver the synchronous sessions, it was vital to have someone who could assist participants with technical issues.

Additionally, while the DEAL course development team decided to have a group facilitator in every breakout group, this may have stifled small group discussion because participants looked to the facilitator for leadership instead of looking within the group itself. An additional staffing challenge was that each synchronous session had seven staff for a course with only 13 participants. Although the staffing model provided a good experience for the training participants, it was resource heavy and not realistic in the long term. Going forward, the R-IV PHTC will explore improving efficiencies in delivering the course, including determining which staff are essential for course implementation.

Also noted was that the DEAL course is time intensive, not only for the developers but for the learners as well. Course participants committed to four 3-hour synchronous sessions, in addition to pre- and intersession activities. It is important to communicate time expectations and firm dates for each synchronous session in the promotional materials and call for applications.

A final lesson learned is that participant interaction is important but can be difficult to achieve in a distance-based learning environment. The course development group felt that participant interaction increased with each subsequent session, perhaps because participants became more comfortable with each other. In a course in which participants may not know each other or have the opportunity to meet in person, it is important to think about ways in which participants and instructor(s) can get to know each other. For the DEAL course, everyone was asked to post an introduction—including a photograph—on the CourseSites discussion board prior to the first session. It is also important to recognize that when offering distance-based instruction, participants may have simultaneous distractions such as email, which adds to the challenge of engaging the participants in meaningful ways.

Next Steps

The R-IV PHTC will offer the DEAL course once a year, and it is anticipated that a follow-up course, Distance Education And Learning Trainings (DEALT), will be offered for a subset of individuals who completed the DEAL course. In DEALT, participants will fully develop a distance-based course. The DEALT curriculum will consist of consultation and some didactic interaction. Individuals who fully develop a distance-based course in the DEALT class will be invited to become part of the R-IV PHTC’s Master Trainer Network and provide trainings to the public health workforce in HHS Region IV on behalf of the Region IV PHTC.

The DEAL course and its follow-up activities—the DEALT course and Master Trainer Network—are designed to increase the availability of training for the public health workforce in HHS Region IV by increasing the capacity and capability of educators to conduct training at a distance. By teaching seasoned public health trainers how to teach in a distance environment and providing them with the resources to translate a course from in-person to distance, the R-IV PHTC is able to address barriers to in-person training and reach the broader public health workforce, building sustainable training capability in the region.