Of 12 educators, 10 agreed to participate in the evaluation. These included six from palliative care and four from neurology/neuropalliative care backgrounds. One was a nonclinical researcher. Four were from the USA, five were from India, and one was from Europe. Of the educators, three identified as mid-career and seven as senior faculty, ranging from 6 to 33 years of experience. Nine of ten reported an academic affiliation and all reported association with a teaching hospital.
The themes identified were as follows: (1) Bridging the global gap; (2) Getting everybody on board; (3) Defining the educational scope; (4) Investing extensive hours of voluntary time and resources; (5) Benefiting within and beyond the curriculum; (6) Understanding the learner’s experience; (7) Creating a community of shared learning; (8) Adapting future teaching and learning strategies; and (9) Envisioning long term sustainability.
Bridging the global gap
Educators agreed there is a need for education and training in neuropalliative care, though they noted worldwide there are few palliative care courses or the courses are limited to specific health systems or diseases. Educators noted online education and training help to disseminate information to a larger community, as there will be a greater demand for palliative care course, and felt this course needs to continue being offered internationally in the future.
Getting everybody on board
Educators noted currently there is little research about palliative care education online and found developing and implementing an online course is a navigation of a complex landscape of policies and requirements which may be specific to institutions, healthcare systems, or countries. Additionally, when tailoring a course to meet the goals of an international community, they emphasized local guidelines, cultural norms and systems of medical practice to consider, and a big challenge to get such varied communities on board. For example, one educator noted that in India, views on patient autonomy may be different than the West, which is pertinent for the clinician teaching palliative care to understand.
“India… is a collectivist society… we as a culture have willingly surrendered a good portion of… our personal autonomy to our families. The golden rule is you treat me like you would like to be treated… But the platinum rule is that you treat me the way I would like to be treated.” (009).
Defining the educational scope
Educators noted that neuropalliative care is an innovative specialty-based model of palliative care, and found that though the entire project was ambitious, it was helpful to consider and develop basic knowledge and skills needed to deliver neuropalliative care.
“I think the stream that brought it all together, these key neuropalliative issues, you know, are really incredibly important to the goal of this course to really focus on specific elements of palliative care for neurological patients.” (003).
“So first we talked about who this course is for? Is it for neurologists? Is it for palliative care specialists? Is it appropriate for both? And is it aimed at non-physicians? So we thought about the audience and the medium: should it be in person or virtual? Should it be a combination? These were the first steps.” (005).
One theme noted by educators was the challenge to focus this course on the specific elements of palliative care for people with neurological problems. The course needed to provide relevant education for both palliative care providers and neurologists, and emphasis was placed on complex decision making. To meet the learners’ expectations and make the course engaging, they noted course content needed to be adapted to answer local questions. For example, changes in content were made to make it appropriate for India:
“I think if I did my best, I would miss the mark, and I would miss the mark in many ways, because there are nuances in the discussion of advance care planning in India and other countries, there are nuances in policy, there are nuances in the care that is provided and available. So I think having a course that’s really practical and real-world will be helpful for providers. You know, it’s helpful to have people who are on the ground and really know these systems.” (002).
Investing extensive hours of voluntary time and resource
“This is the most extensive course I have ever tried to create!” (005).
Educators acknowledged the discussion began during the [Covid-19] pandemic and the contemplation period took more time than expected. Coordination of a large planning group was complex and meticulous. It took numerous long phone calls to understand how online learning works and several months to discuss the curriculum content.
“So we brought these players together for different groups of people and found a common time. I think that was one of the biggest challenges in working together and creating something where everyone could come together. It was difficult, but the result was very positive because everyone was willing to put in the time that was required.” (007).
Despite being pro-bono work, educators admired how many people volunteered to create this program and its content, bringing various resources together to provide a rich and interactive curriculum.
Benefiting within and beyond the curriculum
Educators described benefiting beyond the curriculum itself as being a part of the curriculum designers and learning from international colleagues.
“It’s a journey for me… because this is a first for me. I wasn’t earlier part of any other course module or development techniques.” (001).
Educators reflected that putting the curricula itself together allowed them to learn not only about neuropalliative care, but about what topics may be important to local practice.
“I’m 63, that’s not an age at which I’m going to go do a fellowship now… the best way to learn is to teach”. (006)
Understanding the learner’s experience
Educators noted understanding the audience is vital; the learners were all busy clinicians, and self-paced learning meant that not everyone came prepared. Educators reflected on this lack of engagement and suggested a more rigorous selection process for learners is needed for future offerings of the course. They believed as the goal of a curriculum is for learners to learn, learner engagement and retention of information is imperative. Educators reflected that learner feedback of the course is vital to course evaluation.
“Something that the group noticed was that the palliative care folks were much more engaged than the neurologists. So we really wanted to understand why that was and what we could improve for the neurologists to make it more interesting for them and make them feel like they could really benefit from this course.” (005).
Educators reflected that currently how this course impacted learner clinical practice is unknown. Though available feedback can be used to modify the course, reasons for learner attrition is also difficult to ascertain. Educators felt that for future iterations of the course, soliciting feedback from learners at the beginning and middle of the course may aid in these evaluation gaps.
Creating a community of shared learning
One theme that was reported by educators was that online learning is about building a community, so conversations between course participants are essential. One aim was to make this course a place for networking.
“You might want to divide the participants into small groups to do small projects together. That way they get to know a few others and have a chance to share ideas and set a goal. I also think that the monthly sessions at via zoom should be much more interactive so that the course participants have a lot more say. I think that would be a space for growth.” (004).
Educators reflected that content needs to become more concise to allow for synchronous online activities, regular check-ins about personal practice, and discussions about what was learned. Educators felt that small group assignments improve cross-country collaboration, and allowing time for discussion can foster teaching among learners, as practitioners may know more about the community and its needs than some educators.
Adapting future teaching and learning strategies
Educators identified that there is room for growth; questions abound for what teaching strategies need to be changed next course offering. Currently, the focus is on webinars. Educators felt the content could be consolidated by having some essential knowledge acquisition through self-directed learning and currently the course is very theoretical. They thought it may benefit from more practical cases specific to the clinician’s area of expertise, such as with inclusion of patient and family voices or with more skill development sessions. The bulk of the curriculum focused on current knowledge.
“Put them in break-out rooms, you know, and discuss face to face. That will enhance our learning. And then give them cases, break them up into groups of five, and show them how they could do it. Those kinds of discussions would show what they have learned over the last month. So we need to incorporate more of these skill-based sessions.” (007).
In terms of performance assessment, educators felt the MCQs should be replaced at least in part by practical tasks.
Envisioning long term sustainability
Educators noted in the first year, the goal was to create all the content and get the pilot course started. For subsequent iterations, educators posed questions to consider including: What happens next time? How can awareness be spread about the course? How can more participants attend the live sessions? A course is only helpful if learners complete the course. Would conferring a degree instead of a certificate improve participation? From the educator side, more comfort with the online curriculum is needed:
“I have some people who are known as educators, but they had a very hard time transitioning to online content and asynchronous content and building a community. If you’re not used to watching YouTube, you may have a hard time engaging with it.” (008).
