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Innovation

Antenatal screening: an online learning tool

Many health professionals are involved in ante- and neonatal screening programmes. An online learning resource ensures they can stay up to date with best practice.

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In this article…

  • The role of the UK National Screening Committee
  • Developing an online module about screening programmes
  • Benefits of e-learning for nurses and midwives

 

Authors

Joanne Harcombe is education lead, UK National Screening Committee; Jill Walker is regional antenatal/child health screening manager, NHS Yorkshire and the Humber; Nick Johnstone-Waddell is head of communications, UK National Screening Committee.

Abstract

Harcombe J et al (2012) Antenatal screening: an online learning tool. Nursing Times; 108: 27, 22-23.

The UK National Screening Committee has introduced a new “one-stop” online resource to update NHS staff quickly and effectively on all six NHS antenatal and newborn screening programmes. This article describes how the module was developed and its benefits for staff.

Keywords: Screening/Online learning/Antenatal and newborn screening

  • This article has been double-blind peer reviewed
  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article in the ‘Files’ section of this page

 

5 key points

  1. There are six national antenatal and newborn screening programmes in England
  2. A range of health professionals are involved in offering and undertaking screening
  3. Many professionals find screening terminology and concepts confusing
  4. Online learning enables professionals to learn or update at a time and place convenient to them
  5. Online learning resources are easy to update and improve in response to user feedback

 

”Screening” is a much-used but often misunderstood term, and many people are understandably confused by concepts such as sensitivity, specificity, false positives/negatives and the differences between screening and diagnostic tests. For example, consider the multiple-choice question in Box 1. Are you confident you would get it right? This article describes the development and rollout of an innovative online learning module that enables all healthcare staff involved in antenatal and newborn screening to answer such questions confidently.

Although many health professionals are involved in antenatal and newborn screening, until recently there has not been a high-quality learning resource that provides a quick and effective overview of the programmes and an authoritative introduction to basic screening concepts. This online learning module, produced by the UK National Screening Committee, can form part of mandatory training, pre-registration education and continuing professional development. It is free, enjoyable to work through, auditable and provides learners with up-to-date evidence-based information to ensure they offer women and their families informed choices.

Enabling education

The UK NSC acts as an enabler of screening education. It aims to:

  • Support effective commissioning, implementation, audit and monitoring of programmes;
  • Provide easy access to quality screening knowledge;
  • Promote understanding of: the screening principles and process; screening as a pathway and individual pathways as needed; informed choice, risk assessment and interpretation;
  • Enable users and screeners to actively inform the UK NSC education strategy.

High priority is given to there being easy access to activities and materials to maximise efficacy. Sustainability is at the heart of our strategy; we aim to embed screening information into existing education structures and pathways wherever possible.

Why online learning?

Over the past decade the UK NSC has worked hard to develop and facilitate education and training across the NHS. We have aimed this activity at health professionals to prepare for implementation of new screening programmes, to support significant changes in existing programmes, and to cover generic areas such as informed choice, and commissioning of high-quality screening programmes.

Two national training needs analyses (Harcombe, 2007; Harcombe and Fairgrieve, 2004), annual audits and evaluation exercises have informed the development and delivery of resources. Our strategy addresses the needs of a changing NHS and fits with the aims of the next-stage review (Department of Health, 2008), which include: improved education and training for staff; easy access to high-quality information/education; and NHS organisation and university partnerships.

The training needs analyses showed that while there was a clear preference for study days, there was a conflicting problem with establishing and accessing them because of workload commitments. Staff also said they would prefer screening education to be delivered as an integrated whole rather than as six programme-specific subjects, to reflect the women’s pathway. Considering these findings and the most accessible and effective way to meet our objectives, we decided to invest in online learning and develop a one-stop, evidence-based module to cover all six NHS antenatal and newborn programmes.

 

Box 1. Test your screening knowledge

The term “false positive” can be defined as occurring when the screening test result indicates the woman/baby is:

a) Not at risk of the condition being screened for - but is actually affected by the condition

b) Affected by the condition and this is confirmed by subsequent diagnostic tests

c) At high risk of having the condition - but is actually unaffected by it

d) At low risk of having the condition - and is unaffected by it

 

Building work

The module was developed with key stakeholders, relevant professionals and user groups. Feedback from royal colleges, as well as professional and user groups, informed the core unit content and scenario development. Stakeholders were kept informed about progress and the project team liaised closely with those who would be championing the resource at regional and local level, including regional antenatal/child-health screening teams and lead midwives for education.

The resource was piloted around the country to test for ease of use and appropriateness of content; amendments were made and the module was formally launched in February 2011.

Built around the UK NSC screening timeline, the resource includes key learning points on screening terminology and concepts, overviews of each of the antenatal and newborn screening programmes as well as consistent messages about the core principles of choice and consent, decision making and diagnostic testing.

Learning outcomes

  • After completing the module, users will:
  • Be able to distinguish between screening and diagnosis, and explain limitations and benefits of screening;
  • Be able to give contemporary, balanced screening information to women and families to enable informed choice;
  • Have up-to-date knowledge of NHS screening pathways;
  • Know about quality, satisfaction and safety across screening pathways;
  • Have evidence of CPD.

E-appeal

We considered carefully the appropriate media mix for the module to ensure it appealed to users and engaged their attention, while avoiding the risk of slowing down learning by using too varied a mix. A number of interactive approaches - images, graphics, animated content, filmed and text-based scenarios, voice-overs and filmed verbal explanations of each screening programme’s policy, purpose and benefits - contribute to a blended learning approach. Written and filmed scenarios allow users to reflect on how theory can improve their own practice and skills.

Benefits for nurses, midwives and students

The module:

  • Covers all programmes and concepts related to screening in one stop;
  • Offers flexible learning with self-paced progression;
  • Supports evidence-based, quality care;
  • Offers individualised evidence of learning;
  • Is audit compatible;
  • Helps in meeting mandatory training requirements.

For example, a mature student midwife with children found being able to do the module in her own time appealing. She said it was “straightforward, thorough and convenient” and it deepened her understanding of screening as a whole. It also helped her understand how to present the issue to women and deal with their questions. She will revisit the module every six months.

How it works

When users enter the module they are asked to register. They move through written and filmed scenarios, images, explanatory text and animations to help them remember key messages and relate them to daily practice; multimedia and interactive content makes this learning enjoyable and engaging. The module is designed so users have to work through each unit in turn, ensuring they get an overview of all parts of the screening pathway and how they fit together. This reinforces the key message that “screening is a pathway not just a test”.

Before finishing the module users are invited to complete a short quiz. If they achieve the 70% pass rate they can print a certificate as evidence of learning for CPD purposes. The quiz is different for each user and includes questions from all sections.

Organisations, such as NHS trusts, primary care trusts, strategic health authorities and universities, can have a designated lead who can access a summary report showing the number of people in their organisation who have registered and completed the module. This has been useful for monitoring mandatory training, supervision and student programmes, planning education programmes and for ensuring a fit-for-purpose workforce.

The module can be accessed from any suitable computer with an internet connection, but users are encouraged to register with an NHS or university email address. A central team provides support for anyone needing help. All users are asked to fill in a post-completion survey. The project team monitors the findings; as a result some technical and content changes have been made and feedback given to contributors.

Keeping it vital

Since the launch, a regular updating schedule has ensured content remains up to date. Recent additions include lessons learnt from adverse incidents and the addition of mandatory questions addressing common practice issues. We encourage users to revisit the module annually; those nearing the anniversary of completion receive an email informing them the module will be reset for them to work through again. It takes, at most, 1.5 hours to do so is a realistic annual commitment.

What next?

In the year since its launch, nearly 3,000 people have completed the full module and 5,000 have registered to do so. Evaluations are overwhelmingly positive. A full evaluation will be carried out in 2013 to look at content, accessibility and usage, including a review of the quiz to ascertain any areas of difficulty.

The UK NSC team constantly updates the resource with findings from quality assurance and user feedback to ensure it is a practical and high-quality way for staff to keep up to date with the six NHS antenatal and newborn screening programmes in England. For more information on these visit the UK Screening Portal at www.screening.nhs.uk/england.

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