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AFRO-NETS> Epidemiology Course on the Internet (45)
Epidemiology Course on the Internet (45)
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Friends,
We would like to thank all of you for your excellent comments on the
submission to the BMJ. We have revised the paper based on the comments
received and it has been submitted for "hopeful" publication in the
BMJ. Below is the final draft.
Best Wishes,
Deb, Akira, & Ron
mailto:[email protected]
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A Roadmap to Prevention: A Global Health Network Supercourse
http://www.pitt.edu/~super1
Authors: Global Health Network Supercourse Contributors
http://www.pitt.edu/~super1/main/reviewers.htm
Patrick Crispen has been ignored by the health community, but he may be
ushering in a new age of global training in health. As a graduate stu-
dent, Dr. Crispen sent a simple announcement in July 1994 that he was
starting a training course to teach people how to use the Internet, "A
Roadmap for the Information Superhighway". His lectures were funny, in-
formative and interesting. Many of us received our first Internet over-
view and we loved it. The importance for health was that between July
and October 1994, 65,000 people from 77 different countries took the
course, making it one of the largest global educational experiences.
Why can't we in health create a Roadmap course on prevention to take
people onto the Internet and prevention Information Superhighway? Why
can't we inexpensively diffuse the latest health and Internet knowledge
to thousands if not hundreds of thousands of people worldwide? Why
can't a Health Roadmap type of course be the foundation of global
health information systems? We believe it can.
During the same time period when Roadmap came out, we introduced the
concept of a "metaschool" that would train students around the world
using the Internet (http://www.pitt.edu/~rlaporte/ref2.html). Now the
technologies are available to make this concept a reality. As we enter
the next millennium, health has become global. An epidemic of flu in
chickens in China can reach Ghana, Peru, and Japan within hours by air-
plane. HIV infection likely has spread by infected people migrating to
other areas in airlines, drug abuse is an international problem, and
the globalization of the food supply leads to multinational food borne
outbreaks. Despite the fact that many of the most vexing public health
problems are global, training of students in epidemiology and preven-
tion is local. This can be remedied.
Towards the Establishment of Global Telepreventive Medicine Training:
As professionals we teach health courses to students in many different
disciplines. Our didactic classroom lecturing has changed little in 200
years. In contrast, during the past 25 years information technology
(IT) has improved a million fold. It is time that we in health begin to
harness the IT revolution to improve training in Telepreventive Medi-
cine and in fact, in all other health disciplines.
Public Health has made tentative steps towards incorporating distance
learning. The primary mode of distance learning has been satellite
based, with an instructor on camera at one site, and students at an-
other site. This approach attempts to mimic the classroom. However,
these systems are "talking head" approaches in that one sees the talk-
ing heads of the instructor, with little other interaction. In addition
they are very expensive, and the students need to come to a central lo-
cation, thus limiting their use to all but the richest countries. De-
gree granting institutions are also moving forward with distance learn-
ing some of which is on the Internet. They however reach only a small
number of people in part due to the costs of tuition which often range
over $10,000 per year, thus limiting global utility.
Harry Truman once described atomic energy as "a new force too revolu-
tionary to consider in the framework of old ideas". A half century
later we are confronted with the Internet - another revolutionary
force. Although it can be used to support conventional tasks, it also
offers new ways to carry out entirely new tasks for those with suffi-
cient vision" (1).
The Internet is perhaps the most powerful tool for global teaching. It
is a transparent, cost-effective medium. It is cheap, and becoming
ubiquitous. In addition the format of the system, with hypertext links,
point and click can lead to very powerful new modes of cognitively
based training. In addition, it is a very friendly medium, and it
breaks down the hierarchy between professor and student, students in
Asia and students in Latin in America. On the Internet, people are
equal. With the power of the Internet for the first time we can use the
best teachers in the world to teach the best talents to prevent dis-
ease.
Collaboration with leading experts in the Internet community has led us
to a different model of international training. We have established the
first global Internet based Supercourse. This course employs new ap-
proaches to use the power and cost/effectiveness of the Internet. It
designed to be the first step for a global architecture of health in-
formation and data that can be used for teaching, research, and provid-
ing information to the lay public. It can be a model for other disci-
plines.
A problem in teaching epidemiology is that it is thought to be boring
and of little importance to clinical medicine. Therefore many students
do not like to take epidemiology courses, and many medical, nursing,
and other health profession schools do not even offer courses in epide-
miology and public health. Moreover, there is only a limited knowledge
of the use of the Internet in health institutions across the world. We
have set out to improve global knowledge of epidemiology, public health
and the Internet by constructing a "roadmap" to a multilingual course
that thousands of students worldwide can take at the same time.
Faculty: The most important faculty person is the person heading the
class at each individual institution. Instructors in China, Peru, Mos-
cow, etc. would have complete control in choosing which lectures, or
parts of lectures they will include in their course. The modular nature
allows faculty to pick and choose lectures. In addition, the local fac-
ulty can work with an external faculty of the GHNet Supercourse. The
external faculty represents over 500 people from 48 different coun-
tries, with most from academia. These individuals were recruited to
share their knowledge by sending messages to various health, public
health and telecommunications lists. In addition to the individuals
from academia, we have people from Ministries of Health, large corpora-
tions (e.g. IBM, AT&T), NASA, WHO, PAHO, etc. who have joined this ef-
fort. The external faculty serves to write, review, and translate lec-
tures as well as serve as consultants to local faculty. The instructors
of the course will evolve from that of lecturer to mentor as the course
is designed to teach students how to find information, rather than feed
facts to the students.
Lecture Format: The lectures are "information modules" in that a packet
of self-contained information is available from each lecture. Moreover,
each lecture is a "locator" as hypertext links take one from the lec-
ture to other pertinent modules of information in the course, other
lecture series or elsewhere on the Internet. One format, "the hypertext
comic book", is used extensively (http://www.pitt.edu/~debaaron/htcb.
html). Embedding hypertext links in figures/slides and then converting
the slide presentation into html format can be easily done with a stan-
dard graphics program. The course is established according to cognitive
psychology theories, whereby, pointing and clicking into each link
takes one to deeper levels of information and comprehension. Within one
year we expect to have 50 lectures available. The following is a list
of the initial lectures that are currently under review:
- Introduction of the Supercourse
- Epidemiological Transition
- Disease Monitoring
- Epidemiology of IDDM
- Rheumatic Fever/Rheumatic Heart Disease
- Toxic Oil Syndrome
- The Internet and Epidemiology
- Application of Internet to Epidemiology and Public Health
- An Introduction to Health Economics
- Hodgkin's disease
- WWW as a Global Virtual Library
Local Use of the Course: An instructor in Mexico City can decide to use
one of the lectures, some of the lectures, all of the lectures or parts
of the lectures. The information modules can serve as a course unto
themselves or be used as supplemental information for traditional
course lectures and textbooks. We envision that other lecture series
can also use the modules to supplement their curriculum. Thus a local
course on diabetes and its complications might want to include an in-
formation module on diabetes epidemiology, or one on the Internet as a
public health tool. Global courses need to be sustainable, and not tar-
geted primarily to developed countries. In this course over 10 faculty
members are from Africa, 10 from the former Soviet Union, and 15 from
Latin America. As the course develops during the next few months, we
will have at least 10 lectures from people in developing countries.
Texts: The British Medical Journal has agreed to put two excellent
textbooks on the Web for our use, and others. This is to our knowledge
the first time that major medical texts have been made available on the
web. We can thus interlace each lecture with links to specific pages or
paragraphs in a textbook.
Peer Review: All lectures are peer reviewed by the global faculty be-
fore they are used in the global class setting. To our knowledge this
is the first global course directly monitoring the quality of lectures
through peer review. At the end of each lecture there is a review form.
The first lecture has been peer reviewed by 73 faculty members world-
wide of which 31 (42%) have previously taught an epidemiology course.
If the reviewers agree, the reviews are anonymously posted on the web
site along the ratings. The average rating for lecture 1 was 3.8 out of
5 overall and 63 (86%) indicated that the lecture would likely be well
received by students. A total of 65 comments were posted on the web,
which provides guidance to the author of the lecture for the revision.
In this manner we have the top faculty critiquing the lectures for the
initial review process. As students around the world take the course,
they will also be able to review and critique the lectures. With the
students' ratings, a continuous quality appraisal mechanism based upon
Deming principles is thus set up. Annually each lecture will be re-
viewed, and the comments assessed to determine if the ratings have
changed and provide feedback for the author to modify and improve the
lecture.
The strength of the Internet is that we are also able to track usage of
each lecture. By putting counters on each lecture, we can determine
when and where the lectures are being used. As more and more people be-
gin to write lectures, they will be added to the Supercourse. The "mar-
ket place" will determine which are most used, thus if there were two
lectures on the same topic, the local instructors across the world will
determine which lecture they will use in their course.
Languages: The course is currently being translated from English into
Spanish, Japanese, German, Turkish, Portuguese, Malay, Korean, Chinese,
French, and Russian.
Mirrored Servers: We have found that figures are often slow to come
down. To alleviate this problem we will set up mirrored servers in
various parts of the world, hopefully within every country. A mirrored
server is a copy of the course put onto another computer and every time
the lectures are changed on the primary server they will automatically
be updated at the mirrored sites. With the mirrored sites, a student
from Russia can access the course from a server in Moscow, or a student
in Chile can the course from a server in Santiago.
Interactivity: The Internet by its nature is an interactive medium.
Students from across the world can begin to talk with each other. Also,
we will have "meet the professor" where students from Tokyo can discuss
"Malaria in Peru" with faculty members in Lima. We are also determining
the feasibility of a global Internet game of health where thousands of
students can work together to stop an epidemic of an infectious disease
in Uganda from moving north to Europe and west to Russia, China and Ja-
pan, or tainted hamburger from the U.S. shipped to Brazil, Spain, and
Georgia.
Course Credit: There is no central university awarding academic credits
for this course. Instead, it is under the control of the local instruc-
tors. The goal is not to replace the local instructor, but rather to
enhance their efforts by providing modules of information that can be
used in the classroom setting. The course can also be accessed by lay
people or by anyone across the world who is interested in disease pre-
vention. It thus will be possible to bring the prevention message to
health professionals as well as the lay public around the world.
Conclusion: We believe that a new approach towards global medi-
cal/health education can be established be using the Internet. We would
envision that other disciplines would develop lectures in parallel to
this with hypertext links between lectures and information sources, so
that a course in epidemiology can link directly in biochemistry, or
cellular biology. There are many excellent instructors all over the
world. However, many do not have access to the latest health and pre-
vention information. Moreover, most of us would love to have assistance
from the leading experts around the world in teaching our courses, with
the Internet this is now possible.
It is our belief that this effort can be the beginning Roadmap to im-
proving global information in health. We would hope that other disci-
plines would develop something similar so that our Information Super-
highway has off ramps to biochemistry, surgery, nutrition, etc. If we
start out with a good Roadmap for health then our students and we will
not get lost. We would be pleased to help you set up your own Global
Internet Course in your discipline.
(1) Cimino, JJ. Beyond the Superhighway: Exploiting the Internet
with Medical Informatics. J Am Med Inform Assoc. 1997;4:279-284.
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