MEDEV

School of Medical Sciences Education Development

Introduction

The Masters programme in International Primary Health Care at University College London is a fully online, part-time course for experienced professionals, working in primary health care settings. It aims to promote teaching and service development in primary health care and high quality research in an international context.The course is aimed primarily at senior clinicians, researchers, policy makers and leaders in education, with graduates making a significant contribution to primary care development and the establishment of infrastructures for research and teaching programmes in their own countries and regions.

Our eighth intake of students will begin their studies in September 2006, making it one of the UK's longest-running online programmes. The course was conceptualised and is directed by Trisha Greenhalgh, professor of primary care at University College London. It has attracted students from 16 different countries and nine different health care professions from 17 different undergraduate disciplines, creating an incredibly rich learning community in which multiple perspectives and culturally diverse resources can be shared. In addition to introductory modules on the academic study of primary care, principles of research and evidence-based practice, and international comparisons of health care systems, students can choose modules on quality improvement, health informatics, and getting research into practice and policy. They also undertake a dissertation in primary care research, systematic review, service development or teaching and learning.

In being awarded the Times Higher/Higher Education Academy eTutor of the year award in 2005, the course was commended for its orientation towards the pedagogic process, the way in which the student experience informs the rationale and design of the course, and its strong team approach to all aspects of course development and teaching. The judges liked the fact that, even though a fully online course, the technology was very much secondary to the pedagogy, with an explicit commitment to clear educational principles.

Our teaching and learning is firmly based on a constructivist pedagogy (see Box 1), a particularly appropriate approach for the academic study of primary health care, the intellectual basis of which draws judiciously and eclectically upon a wide range of disciplines. The constructivist approach also fits well with the needs of the students, who can be characterised as post-experience learners, working as part of multidisciplinary teams within complex, continuously evolving organisations, and seeking learning predominantly for its applicability to problems in the work environment - hence a key need is for transferable problem-solving strategies rather than competences per se. This has been described as educating for capability.(1)

The course is designed so that collaborative learning is central to the student's learning experience. Early in each unit learning activities encourage students to talk with colleagues in their workplace, or to engage in some other collaborative learning activity in an authentic setting. Then students come together in the online environment for a concentrated period of tutor-facilitated and student- moderated interaction (typically for two weeks) in the form of a virtual seminar. The virtual seminar is designed so that the tasks the students undertake are explicitly linked to the assignment for each study unit. The seminar becomes an opportunity for students to present initial ideas, focus, reflect upon, and refine their ideas. Through online discussion the students are able to actively construct knowledge. They have the opportunity to practice and develop their higher order academic skills. They share and learn from each others' experiences and perspectives and they get exposure to different approaches to problem solving and learning. These benefits of distance and collaborative learning for work-based learners are highlighted in the following quote from one student, a missionary doctor in a remote part of Tanzania: Despite my remoteness and perhaps slightly unusual job description, I have enjoyed being in the virtual environment of the course and with professionals from across the world. Different perspectives on problems provide new insights and stimulate learning. I look forward to continuing with the course and applying that learning as I continue in my everyday work here.

Quality improvement is high on the course agenda. Our course team has researched and developed a detailed quality framework,(2) which sets out a clear vision for quality, and provides a succinct set of standards and measurable success criteria for each of the key components of the course: course materials, the interactive learning environment, tutor performance and development, assessment, student communication and support, and administrative and technical support. We are currently undertaking an innovative action research project in collaboration with colleagues from other online courses to develop models of peer observation of teaching in the online environment.

Box 1. Characteristics of constructivist teaching and learning(3)

• Multiple perspectives and representations of concepts and content are presented and encouraged.
• Goals and objectives are derived by the student in negotiation with the teacher.
• Teachers serve in the role of guides and facilitators of learning.
• Activities, opportunities, tools and environments are provided to encourage meta-cognition, self-analysis, self- regulation, reflection and self-awareness.
• The student plays a central role in mediating and controlling learning.
• Learning situations, environments, skills, content and tasks are relevant, realistic, authentic and represent the natural complexities of the real world.
• Primary sources of data are used in order to ensure authenticity and real-world complexity.
• Knowledge construction and not reproduction is emphasised.
• This construction takes place in individual contexts and through social negotiation, collaboration and experience.
• The learnerÕs previous knowledge constructions, beliefs and attitudes are considered in the knowledge construction process.
• Problem-solving, higher-order thinking skills and deep understanding are emphasised.
• Knowledge complexity is reflected in an emphasis on conceptual inter-relatedness and interdisciplinary learning.
• Collaborative and cooperative learning are favoured in order to expose the learner to alternative viewpoints.
• Assessment is authentic and interwoven with teaching.