We established The Asthma Education Clinic (AEC) to meet a country-wide need for reliable, consistent training and materials for asthma educators and health workers. Almost immediately, we ran into a problem – how could we provide these professionals with the education they required for certification in a simple, easy and inexpensive manner?
In 2001, health care professionals who wished to learn about asthma were forced to attend weekend courses. In the span of 12 to 16 hours over two days, they listened to lectures that tried to give them both the essential asthma knowledge they needed, and also attempted to explain how to teach patients. From long experience, we knew that such a "force-feeding" approach was wrong in every way. Learning takes time – time to understand, time to assimilate, and finally to put into practice the newly-acquired knowledge.
The weekend approach was also expensive, with travel, hotel and other costs. It also took away precious weekend time from family.
Clearly, some kind of alternative approach was necessary – one with low costs, with gently-paced learning over a number of weeks rather than a weekend, with teachers who could answer questions, and where students could study in the evenings, after work, in a relaxing environment. But what, and how? We needed answers.
We conducted a survey and discovered that many health care professionals did not have computers at home (this was, after all, 2001) or e-mail addresses. A computer-based live course was hence out of the question. It became clear that our approach, to be successful, would have to use readily-available and familiar technology.
The solution we devised was to offer our courses by telephone. We would send course materials and textbooks by mail, conduct live classes by phone, and allow students to interrupt and ask questions, just as in a classroom. The only difference: they would take the course from home, or work, and not be physically present in our "virtual" classroom.
History of Asthma 401
Using these criteria as our starting point, we developed a course for asthma educators, now designated "Asthma 401", to be taught over eight weekly lectures of two hours using the ‘teleclass’ format. Asthma 401 was carefully structured so that each class built on material taught in the previous class. More importantly, each class provided students with at least one "take away" – a concept or practical teaching technique that they could try for themselves at work the very next day. Classes were scheduled for the evenings so as not to disrupt participants’ working days. The course could be taken from the comfort of home. Travel was not required. Weekly classes were designed to be two hours in length – the optimum length of time before fatigue would set in and concentration begin to wane.
Class size was limited to 15 to allow for effective instructor-student and student-student interaction, and two live (not recorded) instructors taught each class. Each was a Certified Asthma Educator with at least ten years of clinic or hospital experience with asthma patients. The instructors’ very different backgrounds provided participants with a wealth of situational experience, and different points of view on how best specific situations might be resolved. Throughout each course, the emphasis was on teaching techniques, with many of the techniques being modelled by the instructors.
Asthma 401 was a resounding success. Professionals from all levels – RTs, RNs, Medical Assistants, Case Managers and physicians – from all over North America (and even Alaska) recognized the inherent advantages the teaching method offered, and very quickly enrolled each time the course was offered.
Asthma 401 was formally and rigorously evaluated after it had been presented 14 times in the first three years. 97% of participants were individually interviewed by phone mid-way through each course. At the end of the course they were asked to complete an evaluation form, which 40% completed and returned.
None of the participants had taken a telephone-based course before. All of them (100%) stated that the course either met or exceeded their expectations. 87% of the students who completed the Evaluation Form found the teaching approach suitable, while 5% were unsure and 5% would have preferred classroom teaching. Lack of visual contact was cited as the major drawback: 12% would have liked to see the instructors and other participants.
Classes were conducted on Tuesdays at 8 pm Eastern Time. Participants found the mid-week class format beneficial for it allowed them to return to work the next morning and put into practice what they had learned the previous evening. Immediacy of application was reported by all respondents. All respondents felt that the course made them better educators and more sensitive to patients’ needs. Networking with educators from across the US was seen as an added benefit.
Because computer-based video was in its infancy in 2001, video demonstration of the correct use of medication devices was impossible. To overcome this limitation, the customized course materials included detailed and illustrated "how to" instructions. The lack of hands-on teaching and video proved in practice not to be a significant problem.
All respondents thought the structure, pace, and immediate applicability of the course material excellent, and that it was worth their time. They said that both their asthma knowledge and their confidence in dealing with patients had increased markedly. All graduates stated that they were doing more asthma education and also found their jobs more interesting. In the evaluation, they made similar comments. All felt that the course made them better educators and more sensitive to patients’ needs.
This first part of the evaluation was presented as a poster (#P217) at the 2007 American College of Allergy, Asthma and Immunology Conference.
Having evaluated Asthma 401 from the perspective of the participants, a follow-up was done a year later to assess how well the trained asthma educators were functioning in their clinics or hospitals. Of the original 40% who completed the evaluation form, 28 graduates were available for interviews, the rest having changed jobs or become untraceable.
The results showed a remarkable side-benefit that the course developers had not anticipated. Of the graduates interviewed, 93% (24 participants) had been promoted and given more responsibility, including being made instructors and becoming responsible for peer education; 25 were performing many duties formerly done by their physicians, and estimated that they saved their physician 10 minutes or more per patient.
While their jobs involve educating patients, participants reported that their duties also included:
- assessing patients and triggers;
- training patient in use of devices;
- performing spirometry;
- creating action plans;
- giving bronchodilator treatments.
In effect, they were doing jobs (and being trusted to do jobs) that their physicians had previously had to do themselves.
When the physicians and clinic managers were asked how well their Asthma 401 graduates were functioning, their answers were even more surprising. Trained Asthma 401 graduates saved their physicians at least 10 minutes per consultation/visit with an asthma patient. (Times actually quoted varied from 10 minutes to 35 minutes, as shown below.)
The results of the second evaluation were presented as an abstract titled, "An Eight-Week Telecourse for Asthma Health Care Professionals Proves Cost-Effective" at the 2008 conference of the American College of Allergy, Asthma and Immunology.
Asthma 401's teleclass format eliminates the time away from work, the travel and living costs, and the other stresses associated with "traditional" courses. Further, the immediate application of teaching techniques allows participants to systematically learn how to become effective educators. They practise and refine their teaching techniques, learning more (and getting better) each week. They have time to learn. Finally, the additional skills sets demonstrated by Asthma 401 graduates means that physicians can concentrate on the more clinically demanding aspects of their jobs, and delegate a great deal of the patient assessment, training and education to these professionals.
In a separate informal survey, we found that 97% of the graduates reported having passed the AE-C examination at the first attempt. In some cases, graduates called us to tell us they had passed, and to thank us for the outstanding training we had provided.
Our conclusion was that we had exceeded our expectations. Industry comments bear us out: to this day, Asthma 401 is considered one of the best courses of its kind in North America for health professionals and aspiring asthma educators.