Project ECHO (Extension for Community Healthcare Outcomes) uses web-based videoconferencing to train healthcare professionals in under-resourced areas. ECHO relies on the education principles of Social Cognitive Theory, Connectivism, and Community of Practice Theory. The aim of this study was to explore the relationship between Social Cognitive Theory, Connectivism, and Community of Practice Theory and an ECHO program for healthcare professionals in a resource-limited setting.
Setting: We implemented a 1-year pilot ECHO program based in Hyderabad, India, which delivered pediatric palliative care (PPC) training to physicians, nurses, and allied health professionals across South Asia. Each ECHO session began with a short didactic teaching by an international PPC expert followed by a case-based presentation from a participant and group discussion about the case.
Question Development and Interview Process: The key components of the 3 learning theories guided the development of the focus group interview guide. Focus groups, were conducted either in person or by videoconferencing, all focus groups were conducted by one author (MD) and were digitally recorded and then transcribed.
Analysis: Each transcript was analyzed using a direct content analysis approach. Key principles from each learning theory were used to develop the framework for analysis. Themes were classified as evidence that a particular theory contributed to participant learning through ECHO.
Results: The focus groups revealed 3 major themes in the learning experiences of participants: Individual learning needs, workplace teams facilitate learning, development of a global learning community.
Individual learning needs: Participants identified a lack of training in PPC and the needs of their patients as motivation to participate in ECHO. Participants noted that increased access to educational resources improved their ability to learn and reflect.
• “Nobody on my team worked very closely with a child [before ECHO]. I think the ECHO was about finding more confidence through reviewing together.”
Workplace teams facilitate learning: Participation in ECHO stimulated additional team learning outside of ECHO sessions. Reflecting on clinical problems as a group reduced stress and increased confidence to provide PPC.
• “We constantly sit together after the ECHO session. We discuss ourselves and [watch the video of] that session later and then apply it to the job.”
Development of a global learning community: Sharing information from different cultural contexts provided participants with new ideas and approaches to solving clinical problems in their own setting. Language barriers, technological issues, and the perception of cultural differences in communication were the main factors that limited participant’s engagement in ECHO discussions.
• “Someone in Bangladesh that’s doing pediatrics, it’s good to know, since there are not very many of us, that we can reach out to one another and talk about problems we may have.”
Conclusions: Our results indicate that the delivery of ECHO in a resource-limited setting continues to reflect the original educational principles of Social Cognitive theory, Connectivism, and Community of Practice Theory.