{"id":3064,"date":"2019-11-25T03:41:30","date_gmt":"2019-11-25T03:41:30","guid":{"rendered":"http:\/\/fetalradiology.in\/?p=3064"},"modified":"2019-11-25T03:41:31","modified_gmt":"2019-11-25T03:41:31","slug":"mobile-learning-as-an-integral-part-of-samrakshan-iria-national-program","status":"publish","type":"post","link":"https:\/\/fetalradiology.co.in\/?p=3064","title":{"rendered":"Mobile Learning as an Integral Part of Samrakshan IRIA national program"},"content":{"rendered":"<p><b>Authors<\/b><span style=\"font-weight: 400\">: Ramesh Shenoy<\/span><span style=\"font-weight: 400\">, Rijo M Choorakuttil<\/span><span style=\"font-weight: 400\">, Rajalingam Bavaharan<\/span><span style=\"font-weight: 400\">, Palanisamy Devarajan<\/span><span style=\"font-weight: 400\">, Praveen K Nirmalan for the Samrakshan Team&nbsp;<\/span><\/p>\n<p><b>Running Title:<\/b><span style=\"font-weight: 400\"> Mobile Learning&nbsp;<\/span><\/p>\n<p><b>Author Affiliations<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Ramesh S Shenoy,&nbsp; Consultant Radiologist, Lisie Hospital, Ernakulam, Kerala, India&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Rijo M Choorakuttil, National Coordinator for Samrakshan IRIA, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India&nbsp;&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Rajalingam Bavaharan, Fetocare Magnum Imaging and Diagnostics, Trichy, Tamil Nadu, India<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Palanisamy Devarajan, Nethra Scans and Genetic Clinic, Tiruppur, Tamil Nadu, India<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Praveen K Nirmalan, Chief Research Mentor, AMMA ERF, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India<\/span><\/li>\n<\/ol>\n<p><b>Corresponding Author:<\/b><span style=\"font-weight: 400\"> Rijo M Choorakuttil, National Coordinator for Samrakshan IRIA, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India. E-mail: <\/span><a href=\"mailto:rijomc@gmail.com\"><span style=\"font-weight: 400\">rijomc@gmail.com<\/span><\/a><span style=\"font-weight: 400\">&nbsp;&nbsp;&nbsp;<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">Key words<\/span><\/i><span style=\"font-weight: 400\">: Mobile Learning, Education, Samrakshan IRIA, Fetal Radiology, India<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">Mobile Learning (mLearning) can be defined as learning across multiple contexts, including social and content interactions, using personal portable electronic devices. [1]&nbsp;mLearning can thus be considered to include educational interventions using handheld, mobile devices connected through wireless connections to deliver educational content to healthcare professionals in order to remove the constraints of physical infrastructure, distance and time from learning and teaching. The construct of mLearning covers educational approaches, concepts, methods and technologies [2].&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400\">In 2013, the World Health Organization (WHO) had estimated a shortage of 2.6 million doctors worldwide exacerbated by migration from rural to urban areas within countries and migration between countries. [3,4] An important influence on the disproportionate distribution of health care professionals is the mismatch of content of training programs with the necessary skills, competencies, and experience for the context in which trainees will work [5]. Focused information and communication technologies (ICT) are increasingly recognized as platforms that can build robust, dynamic education and training platforms for health professionals addressing relevance and quality. [6,7]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Samrakshan is a nationwide program of IRIA that aims to reduce perinatal mortality in India. The program envisages a holistic and synergistic approach with other programs and approaches in India that are working towards reducing perinatal mortality with a proactive approach by fetal radiologists in India. Samrakshan aims to scale up the use of trimester specific Doppler studies that can help estimate risk for pre eclampsia and fetal growth restriction on an individual basis using a competing risk Bayesian model based algorithm. [8,9]&nbsp; Samrakshan identified three immediate priorities for the scale up a) Standardizing definitions and protocols for pre eclampsia and fetal growth restriction b) Standardizing Doppler protocols including image quality and interpretations and c) improving use of the Bayesian model based algorithms for risk estimation at an individual level.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400\">A SWOT analysis was performed to identify potential strengths, weaknesses, opportunities and threats to the scale up at the national level.&nbsp; The SWOT analysis is presented in brief.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400\">The identified strengths included (but not limited to)<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Support from the Indian Radiological and Imaging Association, the professional nodal organization of Radiologists in India that has approximately 17,000 members spread across India<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Radiology Curriculum that includes a detailed understanding of medical physics, fetal anatomy, ultrasound and other modes of examination<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Trainers certified and familiar with the use of the Bayesian model based algorithms<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Potential for State Level Instructors who can lead the training sessions for their states<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">State and District level branches or chapters of the parent organization, IRIA, that can lead and organize micro level training<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Diversity of clinical material&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Increased penetration of internet and digital services in India<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Increased uptake of portable electronic devices<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Weaknesses<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Time, physical space and distance were identified as weaknesses for a traditional learning model that involved face to face interactions in a physical space (CMEs, Workshops)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Busy clinical schedules and backlog of patients waiting for consultations&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Unavailability or limited availability of qualified personnel who could cover in the absence of consultants<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Annual schedule packed with different CME and workshops<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Connectivity, Travel Time and distance to conference\/workshop\/CME sites<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Follow up support after CMEs and other educational initiatives limited by time, space and physical infrastructure<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Opportunities<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Developing nationwide standards<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Standardizing and harmonizing clinical protocols nationwide<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Reaching out to individual practitioners in remote, rural areas enhancing their knowledge and skills<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Developing 24&#215;7 learning teaching modules accessible to every practitioner<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Developing state level trainer of trainers<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Threats<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Instrument upgradation may be required<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Software upgradation may be required<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Changing habits with respect to protocol based clinical exams<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Changing mind set regarding clinical practice applications already being done and acceptance by other health care professionals involved in fetal and maternal care.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Based on this analysis, it was decided to develop an educational model incorporating case studies from Indian contexts that can be used to demonstrate and educate on the various aspects of Samrakshan. The Need for a 24&#215;7 accessible platform and content that is available through the country was identified. The limitations of CMEs and workshops to provide were considered and it was decided to integrate CMEs with other educational and pedagogical approaches rather than having them as stand alone exercises. The possibility of recording live sessions that can be downloaded, stored and viewed offline was considered. The best possible solution was identified as an internet or cloud based platform that can host content pertaining to different pedagogical approaches relating to all aspects of Samrakshan . These include support for audio visual content, documents, an online library, discussion forums and ability to assess progress of learners through assignments, quizzes and image audits. Several steps were initiated to develop a free learning module accessible to IRIA members 24&#215;7 through electronic devices with the potential to store content offline. These include<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Development of a core pool of trainers<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Development of trimester specific modules<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Content focused on Doppler based exams and components of trimester specific exams<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Case studies<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Use of a Bayesian model based algorithm for risk estimation<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">1<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> trimester preventative and prognostic management of pre eclampsia<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">3<\/span><span style=\"font-weight: 400\">rd<\/span><span style=\"font-weight: 400\"> Trimester stage based management of Fetal Growth Restriction&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Online Data collection forms<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Image Audits<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Till date, from inception in July 2019, a team of 17 instructors has been formed and content pertaining to 1<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> and 3<\/span><span style=\"font-weight: 400\">rd<\/span><span style=\"font-weight: 400\"> trimester focused on Doppler studies focused on pre eclampsia and fetal growth restriction have been uploaded. 16 cases have been discussed in the forums covering diverse cases relevant to the course content and sourced from clinical material in India. Two hundred and seventy radiologists have registered for the courses in the learning platform. Eight hundred and twenty one data forms have been submitted. One hundred and seven pregnant women were identified as high risk for preterm pre eclampsia and 77 women as high risk for fetal growth restriction in the 1<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> trimester and started on low dose aspirin 150mg once daily at bedtime. Abnormal Doppler studies were present in 97 pregnant women in the 3<\/span><span style=\"font-weight: 400\">rd<\/span><span style=\"font-weight: 400\"> trimester who were managed according to the stage based management protocol for fetal growth restriction followed in Samrakshan. Thirty five pregnancy outcome forms&nbsp; have been submitted; there were no maternal deaths and one neonatal death (identified with fetal acidemia and Stage 4 FGR on 3<\/span><span style=\"font-weight: 400\">rd<\/span><span style=\"font-weight: 400\"> trimester Doppler and ultrasound study, referred for immediate delivery to a higher center, live born but neonate succumbed a few days after delivery). The online learning platform has been supplemented by the creation of specific groups on WhatsApp (currently three groups are formed after CME programs in Madhya Pradesh,&nbsp; Tamilnadu and Uttar Pradesh with 64, 77 and 57 members) and a WhatsApp group for the core committees (72 members) of Samrakshan. The WhatsApp groups provide another platform for instant clarifications, information about posting of new educational material, case discussions and focused peer-to-peer interactions within states.&nbsp;<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">References<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Crompton H. A historical overview of mobile learning: toward learner-centered education. In: Berge ZL, Muilenburg L, editors.&nbsp;Handbook of Mobile Learning. London: Routledge; 2013. pp. 3\u201314<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Car J, Carlstedt-Duke J, Car LC, Posadzki P, Whiting P, Zary N, et al. Digital education for health professions: methods for overarching evidence syntheses.&nbsp;J Med Internet Res.&nbsp;2019. 21: e12913<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Horton R, Araujo ES, Bhorat H, Bruysten S, Jacinto CG, McPake B, et al. World Health Organization. 2016. Mar 2, [2018-10-01]. Final report of the expert group to the High-Level Commission on Health Employment and Economic Growth https:\/\/www.who.int\/hrh\/com-heeg\/reports\/report-expert-group\/en\/<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Nair M, Webster P. Health professionals&#8217; migration in emerging market economies: patterns, causes and possible solutions.&nbsp;J Public Health (Oxf)&nbsp;2013 Mar;35(1):157-63<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world.&nbsp;The Lancet.&nbsp;2010 Dec 4;376(9756):1923\u201358.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Crisp N, Gawanas B, Sharp I, Task Force for Scaling Up Education Training for Health Workers Training the health workforce: scaling up, saving lives.&nbsp;The Lancet.&nbsp;2008 Feb 23;371(9613):689\u201391.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">World Health Organization.&nbsp;2011. [2018-11-23]. Transformative scale up of health professional education: an effort to increase the numbers of health professionals and to strengthen their impact on population healthhttp:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/70573\/WHO_HSS_HRH_HEP2011.01_eng.pdf?sequence=1&amp;isAllowed=y<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Tan MY,&nbsp;Wright D,&nbsp;Syngelaki A, et&nbsp;al.&nbsp;Comparison of diagnostic accuracy of early screening for pre\u2010eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: Results of SPREE.&nbsp;Ultrasound Obstet Gynecol.&nbsp;2018;51:743\u2013750.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Figueras F, Gratac\u00f3s E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86\u201398.<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Authors: Ramesh Shenoy, Rijo M Choorakuttil, Rajalingam Bavaharan, Palanisamy Devarajan, Praveen K Nirmalan for the Samrakshan Team&nbsp; Running Title: Mobile Learning&nbsp; Author Affiliations Ramesh S Shenoy,&nbsp; Consultant Radiologist, Lisie Hospital, Ernakulam, Kerala, India&nbsp; Rijo M Choorakuttil, National Coordinator for Samrakshan IRIA, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India&nbsp;&nbsp; Rajalingam Bavaharan, Fetocare Magnum [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[24,26,27,23,25],"class_list":["post-3064","post","type-post","status-publish","format-standard","hentry","category-original-article","tag-education","tag-fetal-radiology","tag-india","tag-mobile-learning","tag-samrakshan-iria"],"_links":{"self":[{"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=\/wp\/v2\/posts\/3064","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3064"}],"version-history":[{"count":2,"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=\/wp\/v2\/posts\/3064\/revisions"}],"predecessor-version":[{"id":3066,"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=\/wp\/v2\/posts\/3064\/revisions\/3066"}],"wp:attachment":[{"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3064"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3064"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/fetalradiology.co.in\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3064"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}