Distance Education for Medical Training in the Pacific

• Technology and Distance Learning
• Training in Public Health Surveillance
• Redevelopment of the Indigenous Physician Workforce

Many Pacific Island health professionals face isolated working conditions with difficult and limited communications as a result of their geographical context. Distance education using new communication tools like e-mail, the Internet and video conferencing, can fulfil medical training needs in the Pacific.

Distance education can offer advantages over conventional methods. It can allow a greater number of students to be trained, at a lower unit cost and over a longer period of time. Distance education in health using e-mail and the Internet allows students to stay in the field and to apply newly acquired theory to their practical working situation.

Examples of such programmes that have been established in the Pacific are:

• Five post-basic nursing certificate courses for health workers have been developed in the Solomon Islands. The project started in 1994 to increase educational opportunities for nurses and to trial distance education as a mean of improving knowledge and practices. The first results were positive and the programme was extended in 1996 to a national distance education programme. Further courses have been developed in Paediatrics and Nursing administration. (Mrs Kenyon from the Solomon Ministry of Health).
• The College of Nursing and Health Sciences at the University of Guam has provided a nursing distance education since 1997 with the help of PEACESAT site operators and course co-ordinators working in Palau, Yap, Chuuk, Pohnpei, Kosrae and the Marshall Islands (Mrs Fochtman, Dean of the College of Nursing and Health Sciences).
• Courses for post-graduate medical training are being developed in surgery, obstetrics, anaesthesia, paediatrics and medicine at the Fiji School of Medicine. The project is funded by AusAID, the Fiji Government and the US Department of the Interior. The first Diploma candidates graduated in December 1998 and the first Pacific trained specialists will graduate at the end of the year 2001 (Dr Fiddes, from the Fiji School of Medicine).

An operational plan for medical distance education developed through panel discussions at the conference included a definition of distance education and considered how to deliver a curriculum.

Distance learning was defined as teaching and learning that is not face-to-face due to geographic (physical) distance. This excludes the face-to-face summer school format and distances created by economic and social status, language, religion, race, education, etc. The panel emphasised that distance learning must have a “written curriculum” and an explicit formative and summative assessment method. On-site local supervision may be used to enhance distance teaching and distance learning.

The panel reviewed the various reasons for distance learning, outlining that it can:

• improve knowledge and skills without the need to leave job and family, avoiding the difficulty of finding replacements when someone goes away to study
• provide a link between learning and current employment
• offer less expensive course delivery, depending on issues of copyright, numbers of students, modes of delivery and number of sites
• improve the status of health workers without loss of income
• offer open access and flexible learning options
• provide a “pre-test” to measure students’ ability to undertake further training
• allow people following a distance education course to develop field programmes that are immediately beneficial to the community they serve.

The panel agreed that a curriculum should reflect the need for health worker training at community level, basic professional level and post-basic level. This may involve part-time or full-time education either in a learning centre or in a community.

Technology and Distance Learning

New changes in technology, including the Internet, have energised discussions about the possibility of new approaches and media for distance education. However, it was emphasised that good written materials would form the basis for distance education.

The choice of media depends on the local situation, target groups and the curriculum and, ultimately, the choice of technology is a local decision.

Within the Pacific, there is already a wealth of existing and developing experience in providing distance education, but activities are largely taking place in isolation.

To enhance and promote distance education in the Pacific, the panel recommended that:

• materials and experiences be shared
• materials be freely accessible to Pacific countries and in the “public domain”.

It was strongly recommended that a Working Group on Distance Education in Health for the Pacific (PacDEH) be established to facilitate the enhancement and promotion of distance education in the Pacific. This working group would be co-ordinated from the Secretariat of the Pacific Community (SPC).

The role of technology was evident in a number of tasks for the working group identified by the panel in the recommended work plan. These included:

• developing a communication tool for all members of the working group (a sublist on an existing network)
• creating a database at SPC and/or the Fiji School of Medicine and/or the University of Guam which would be made available through web pages and would contain the inventory of:
• existing courses
• institutions involved in delivering distance education and in training distance teachers
• Pacific resource persons
• providing this database on a common PACNET/WPHNet web site
• liaising with SPC to provide and facilitate information and communication technology support at both regional and local levels in assessing needs, establishing and maintaining technology requirements, and assisting countries to develop proposals for technology improvement.

Training in Public Health Surveillance

Dr Mahomed Patel, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia, reviewed the training needs required to enhance public health surveillance in the Pacific.

Trained practitioners are essential to an effective system of public health surveillance. Dr Patel noted that various agencies conduct training in surveillance for health professionals from the Pacific, but that such training is not done in the co-ordinated manner required to ensure professional and institutional development aimed at capacity building.

A service-oriented model of training that integrates training in surveillance with training in public health is recommended. Such an approach leaves the trainee in the workplace, and the process of training itself contributes directly to enhancing surveillance and other public health activities.

The benefits of service-oriented training should be sustained through the efforts of trainees and graduates, as well as through the national health departments, training institutions and regional and international agencies. The result will be strong surveillance programmes with national and regional capability for responding to adverse health problems and for promoting a healthy Pacific.
[Click here for Patel abstract]

Redevelopment of the Indigenous Physician Workforce

Dr Gregory Dever, Co-ordinator, Pacific Basin Medical Association, noted that low cost communications in health are crucial to the strategic redevelopment of the indigenous physician workforce among countries of the US-affiliated Pacific Island nations.

In conducting the Pacific Basin Medical Officers Training Program from 1986 to 1996, the University of Hawaii established key strategic objectives to train and support physician graduates from the Freely Associated States of the Federated States of Micronesia and the Republics of the Marshall Islands and Palau.

Inherent in the medical school training process was the familiarisation of students with the use of computers and information systems, and the processes of “store and forward” distance medical consulting.

Traditional medical communications, such as the development of the Pacific Health Dialog, a journal of community health and clinical medicine for the Pacific, have been augmented by rapidly developing electronic communications technologies.

Recently, e-mail and Internet processes have promoted access to and the use of low cost communications in health thereby further reducing professional isolation among the new physician workforce in Micronesia.

The regional development of expanded access to medical information and distance medical communications technologies and processes, including CD-ROM, Epi-Info, Picasso Phone, e-mail and web site-based consultation and medical information search activities, have been implemented to support the professional needs of the regional health workforce.

Such activities have contributed to, and are currently enhancing, the further implementation of the strategic objectives for intern training, in-country postgraduate training and development, professional association development and continuing medical education.
[Click here for Dever abstract]