How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study

Abstract

Background: Zambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials.

Objective: Our aim was to address these challenges by introducing a self-directed, e-learning platform with an offline tablet as part of a collaborative blended-learning intervention to supplement local teaching and training.

Methods: The pilot phase of the e-learning platform was evaluated using a mixed-methods approach with a convergent parallel design. Various methods were employed to test the data's adequacy and potential for generating valid results. Methods included questionnaires according to the technology acceptance model and information system success model by DeLone and McLean, semistructured interviews, learner diaries, pretesting, the collection of usage data, exam results, demographics, and informal feedback. Outcome measures included usage, adoption, efficiency, acceptance, user-friendliness, and gained knowledge and skills.

Results: In total, 52 students and 17 medical instructors participated in the pilot evaluation. The questionnaire results showed a high acceptance of the technology (>80%) and high agreement (>75%) with the e-learning platform. Semistructured interview results showed an overall appreciation of the e-learning intervention, but the need for more e-learning materials. Respondents identified a need for multimedia materials that transfer skills such as medical procedure visualization and interactive exercises to practice procedural knowledge. The learning diaries identified the lack of specific learning materials and potential shortcomings of existing learning materials. However, students were satisfied with the current e-learning content. The majority of students used the e-learning platform offline on their tablets; online e-learning was underutilized.

Conclusions: The pilot phase of the tablet-based e-learning platform to support the self-directed learning intervention was well received and appreciated by students and medical instructors of Chainama College of Health Sciences. E-learning for knowledge acquisition appears to be adequate and feasible for this low-resource educational environment. Our evaluation results guide the further development of the full implementation of the e-learning platform in this educational setting. E-learning materials should reflect curriculum requirements, and additional multimedia and interactive content is needed, as well as improved integration and active participation from medical instructors in the e-learning processes.

Keywords: adoption; effectiveness; evaluation; health care workers; intervention; medical e-learning; rural health; sub-Saharan Africa; sustainability.

Figure 1

Convergent mixed-methods design of the evaluation of the Medical Licentiate (ML) e-learning intervention. IS: Information System Success Model; TAM: Technology Acceptance Model.

Figure 2

Age of Medical Licentiate (ML) students depicted in six age groups.

Figure 3

Uninterrupted years of medical practice of Medical Licentiate (ML) students.

Figure 4

Questionnaire results of medical instructors based on the Information System (IS) Success Model. CCHS: Chainama College of Health Sciences; ML: Medical Licentiate.

Figure 5

Questionnaire results of medical instructors based on Technology Acceptance Model (TAM). ML: Medical Licentiate.

Figure 6

Questionnaire results of Medical Licentiate (ML) students by model type (Information System [IS] Success Model and Technology Acceptance Model [TAM]).

Figure 7

Number of learner diary entries per month during the pilot phase January-May 2017.