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.