Design Overview: Childhood TB for Healthcare Workers

Childhood TB for Healthcare Workers, a six-module online course for which I was the learning designer and developer, launched yesterday on World TB Day. This course was a project of The Union in collaboration with the World Health Organization.

I’m going to give a high-level overview of the design here.

A challenging part of diagnosing tuberculosis (TB) in children is that it’s a big picture diagnosis. Even in settings that have access to the tests used to confirm TB in a patient (and some facilities don’t have these tests), the results will be negative for most children, even if the child does have TB.

So, from the outset, this course couldn’t just be about memorizing procedures and test interpretations; we also needed to give learners a way to practice using clinical judgement. Self-paced online learning can be a great practice space to make real world decisions without the consequences of real world mistakes. Here, we wanted a practice space that would help build learners’ competence and confidence in assessing a variety of clinical symptoms and risk factors to diagnose childhood TB.

As much as possible, we tried to design interactions that reflected real world activities, decisions, and thought-processes. For example, in each diagnosis case, learners ask questions to uncover the patient’s history and gather notes.

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Next, they select body systems to prioritize in an examination and plot the patient’s weight to assess ongoing trends.

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After considering their notes from the history and examination, learners decide whether to order additional tests to confirm a diagnosis. As shown below, these tests may not always be available in the location where the patient is being seen, so learners sometimes need to decide whether to send the patient away for the test.

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As noted above, many children will not have a positive test result that confirms TB, which means that diagnosing TB in children requires clinical assessment and judgement. To promote this type of “big picture” thinking that takes into account a variety of symptoms and risk factors, learners identify (and highlight) notes that suggest TB at each stage. Learners can then review these notes later as they make decisions about diagnosis and treatment.

In addition to practicing the skills needed to diagnose TB in children, learners also develop treatment regimens, offer counseling, and conduct follow up visits.

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Screen Shot 2015-03-13 at 5.56.48 PM Other, non-case-based activities include analyzing data in a clinic, performing contact tracing, determining which patients should receive preventive treatment, and implementing infection control techniques in a clinic.

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Whether case based or not, all of the activities are designed to help learners quickly see how information in the course is relevant to real life, and hopefully give them the practice they need to be able to implement the same skills and decision making on the job.

At the end of the course, learners practice and assess what they have learned in earlier modules by making decisions about a series of patients in a comprehensive practice module.

Childhood TB for Healthcare Workers is freely available from the (also newly launched) Childhood TB Learning Portal.

Other Ways to Inspire Change

What interests me most about learning is its potential to inspire change: ideally a measurable change in behavior, but barring that, at least a shift in attitude or understanding.

Very often, we decide we want something to change, we decide to create a course, lesson, document, or some other package of information that learners will absorb and, voila, change!

What if, though, in many cases it’s not actually a lack of information that’s preventing learners from doing things differently?

A couple of weeks ago, I was pondering how to create educational games that allow learners to practice avoiding common advertising tricks. I had hit a wall after play testing several game prototypes. Simultaneously, I was also lamenting the existence of holiday gifts, and how much pressure there is to buy meaningful gifts for an ever-widening circle of receivers within a commercial sea of expensive candles and scented lotions.

That was the moment of inspiration for Gift Instead, my latest project.

What if, instead of trying to teach about advertising, we just gave people tools to opt out of the whole purchase-more-oriented system – well, at least for giving and receiving holiday gifts this year?

Gift Instead is a web site that lets users create, customize, and share purchase-free gift lists. Users can explore prewritten ideas for purchase-free gifts, but they can also create their own.


My awesome husband Brian did most of the heavy lifting with piecing together a framework for the site and was my brainstorming partner in making this project come alive.

I’m really excited about the site we created. It’s still officially in beta mode, but it’s a very functional beta: please feel free to try your hand at creating and sharing a wish list and do send me any feedback about your experience.

I’ll probably revisit the idea of educational games about advertising schemes in the future. However, I really enjoyed working on another potential path into that same sort of change – less needless stuff purchased – by creating a tool rather than a packaged educational experience.