By Edward King, Chief Innovation Officer and Samantha Parsons, General Manager, inPractice Africa, www.inPracticeAfrica.com
In resource-rich settings, the Internet has transformed both the form and function of much medical education and information. Textbooks are often out of date even before they appear on bookshelves, given the long lead times for print publishing, and therefore many online digital textbooks have emerged that can be updated instantly. Likewise, older forms of pre-service and in-service medical education have been transformed by digital education approaches that are highly responsive to new data and use interactivity such as case studies, test questions, and simulated patient encounters. Digital resources that aggregate, index, and interpret the accumulated body of medical knowledge have made it faster and easier than ever for clinicians and researchers to learn what their colleagues have discovered.
In summary, the benefits of digital medical education and information are so clear that they have rapidly become the norm in settings where cheap, high-speed, always-on Internet is readily available. Conversely, there is a critical need to find ways to overcome the barriers that prevent all clinicians from sharing in these benefits, regardless of their geographic location and resources.
Specifically, in settings where the Internet is unavailable, unreliable, and/or costly, clinicians are deprived of these tools that could increase their knowledge and competence in providing the best possible care. Moreover, even when clinicians in resource-constrained settings do have Internet access, they find that most digital medical resources were written for a different audience and assume that they have access to diagnostics, treatments, equipment, and support services that do not exist in their own setting.
As a result, the efficiencies that digital medical information can provide are kept tantalizingly out of reach. For example, much medical education in resource-constrained settings continues to take place as in-person training sessions, which requires thinly stretched clinicians to travel lengthy distances and be absent for multiple days from the patients who require their care. As another example, many educational resources are produced in offline formats such as printed manuals, CD-ROMs, or PowerPoint slidesets that cannot then be updated when treatment options or guidelines change, so outdated information circulates long after it has become redundant.
Many groups are working hard to overcome these barriers—supporting the ongoing spread of Internet access (especially mobile Internet); developing telemedicine systems that share knowledge between the well-resourced and the under-resourced; devising new medical tools for tablets and phones; and so on. But there is still much, much further to go.
Our own response to these challenges was to develop inPractice Africa. After listening closely to experts and colleagues and researching the issues, we realized that we could make adaptations to our own widely used point-of-care reference and education resource for specialists, inPractice.com, to address the needs in resource-constrained settings. In partnership with Foundation for Professional Development and the University of the Witwatersrand in South Africa, we raising grant support from a public-private alliance of USAID/PEPFAR and 4 pharmaceutical companies (Abbott, Gilead, Janssen, and Merck) to produce inPractice Africa.
inPractice Africa comprises 3 curricula written by South African faculty specifically to address the needs of clinicians in their country on implementing national guidelines on ART, managing TB in HIV-coinfected patients, and the fundamentals of nursing care for HIV. We also developed a database of prescribing information for HIV and TB drugs used in South Africa, and a comprehensive collection of full-text practice guidelines. These are all available on a low-bandwidth Web site as well as through an installable Windows program and apps for Android and Apple phones and tablets.
The 25 modules can be studied systematically as a training course, with CPD credits for completing each module and a certificate for completing each curriculum. But we also ensured the modules, drug information, and guidelines can serve an additional purpose: the Web site and apps allow them to be searched quickly and efficiently to find precise answers to specific questions at the point of care.
Finally, to overcome the digital divide, the Windows and mobile apps can each be used entirely offline, so they can be installed once then used everywhere, regardless of the availability of the Internet. Moreover, all the key features are still available while offline, including search, taking CPD tests, and all the content of the modules, drugs database, and guidelines. If and when the device does go online again, the software downloads any updates to the material to ensure it is kept up to date, and uploads details of test taking and other user participation data.
Following the success of the pilot program, we are now in discussions with funders and partners in South Africa and multiple other countries to develop new inPractice Africa programs for their settings on diverse aspects of medical care.
That’s our ongoing contribution and commitment to overcoming the barriers to online medical education and information. We’d be happy to share more information (email firstname.lastname@example.org) and interested to read about your own projects in the comments section of this blog.