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Evaluating the effectiveness of swine flu contingency policies in healthcare education

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Staff and student sickness may cause disruption in healthcare education during the flu pandemic; this article explores how to implement and measure e-learning strategies


Polly Lee, MSc, BA, DipN, FHEA, RSCN, RM, RGN, is lecturer in child health, School of Community and Health Sciences, City University, London. 


Lee, P. (2009) Evaluating the effectiveness of swine flu contingency policies in healthcare education. Nursing Times; 105: 35, early online publication.

Swine flu has brought about the need to implement policy quickly, not only in healthcare but also in healthcare education, which has considered greater use of e-learning during potential disruption to classroom teaching.

This article looks at measuring the success of these alternative teaching methods by using the known tangible benefits of e-learning. Consideration should also be given to supporting students on placements during this time, and as a consequence, some possible future areas for development are identified.

Keywords: Swine flu, Pandemic flu, Healthcare education, E-learning

  • This article has been double-blind peer-reviewed.


Practice points

  • The swine flu pandemic means that healthcare education may need to consider rapid implementation or further development of e-learning strategies.
  • Healthcare educators who want to develop technology enhanced learning should consider where their current efforts sit on the e-learning spectrum (Joint Information Systems Committee, 2008) or a similar framework.
  • Some issues may be well defined, and assessments may be in this category. Some issues such as giving audio feedback on assignments may be at the early stages of implementation for most higher education institutions (North, 2009; Rotheram, 2009; Merry and Orsmond, 2008).
  • Other issues such as student engagement are less well defined and therefore any tangible benefit may not be fully measurable for some time (JISC, 2008).
  • Considering such a spectrum will help both policy implementers and policymakers to decide on local priorities.



Healthcare organisations have prepared for and are currently implementing policies for the swine flu pandemic. Likewise, healthcare education must prepare for the possibility that teachers and administration staff may be absent, so buildings may not be able to open.

While both pre registration and post registration students may be ill, the latter group may also be prevented from attending classes if they are required to provide direct patient care and planned study leave is cancelled.

Healthcare education must, therefore, prepare to use alternative teaching methods if teaching is disrupted by the flu pandemic. Educational organisations have quickly implemented various policies to minimise any possible disruption to students.


Policy is generally considered to be a directive to be implemented, normally through vertical structures such as those from government level, or sometimes more locally at an organisational level such as a hospital or primary care trust. In healthcare and healthcare education policy is sometimes viewed with suspicion, as a way of management imposing wishes, cost saving measures or efficiency savings.

Conversely, patient groups may spend considerable time lobbying for policies to be accepted at government level. For an issue to be deemed relevant by a policymaking body, it needs to be timely, and there is sometimes a small window of opportunity for an issue to be turned into policy.

Lord Laming’s (2003) report on the death of Victoria Climbié led to timely policy implementation. A raft of government policy on all aspects of childcare was published, the most well known of which was Every Child Matters (HM Government, 2003). This green paper built on existing plans to strengthen preventative services and has since prompted numerous other policy documents.

After the death of Baby P (now known as Baby Peter), a review of implementation of these policies revealed that in some authorities there was still considerable room for improvement, and this has been debated widely in the media (Fresco, 2008).

With the World Health Organization recently declaring the A(H1N1)v influenza virus as a global pandemic, various policies have been implemented quickly. These aim to prevent the spread of infection or to manage healthcare in the event of either an overwhelming number of patients and/or staff shortages due to a worsening of the pandemic.

In higher education institutions (HEIs), similar policies for managing possible disruption to teaching by student and/or lecturer sickness have already been implemented; these will normally rely on increased use of e-learning.

Policymakers at HEI level include a range of people including those from e-learning/educational development departments, heads of departments, academics, administrators and technical support staff such as those who manage information and communication technology services.  

HEI policy for swine flu

At the most basic level any HEI policy includes ensuring that lecture notes are made available via its virtual learning environment (VLE), a technique previously described by Lee (2009). However, e-learning is much more than simply uploading lecture notes, and some HEIs already have far more developed e-learning policies.

Several authors have attempted to define e-learning (Clarke 2008; Santy and Smith, 2007; Glen and Cox, 2006), while various education organisations have also attempted to do so, such as the Joint Information Systems Committee (2008) and the Higher Education Funding Council for Wales (2007). However, there is currently no common agreed definition of e-learning. 

In developing e-learning, consideration should be given to the different learning styles of learners (Honey and Mumford, 2006). To go some way to accommodating this, the use of discussion groups (Simpson et al, 2008; Vesely et al, 2007) and some advantages of asynchronous (at different times) and synchronous (real time synchronous discussion) have been outlined (Lee, 2009). Where necessary, training is currently offered to those who may still, for whatever reason, not feel prepared to manage such learning using VLEs.

Lobbyists or activists for e-learning or technology enhanced learning (as it is often referred to) are perhaps using the swine flu issue to push for further technology enhancements to learning. These people are policy-implementers rather than policy-makers.

Further enhancements to learning could be achieved by implementing technologies such as synchronous audio conferencing – either through the standard telephone, or voice over internet protocol (VOIP) such as Skype. The latter may also incorporate using web-cams and is similar to video conferencing, although the video method can also have multiple screens to see participants and for the “lead” to simultaneously use presentation software such as PowerPoint. This system could also be used for academic colleagues to continue to meet synchronously, although these interventions assume that teachers have access to broadband technology if required to work from home.

Other enhancements to overcome possible teaching disruption may include pod-casting and further use of HEIs’ e-portfolio system such as PebblePad (see Some of this may include ‘blogs’ and therefore an aspect of Web 2.0 learning, although if used in a closed system, such as one belonging to an HEI, it is really considered to be Web 2.0 learning.

Measuring the success of policy implementation

The real learning from this potential push to increased technology-enhanced learning will come once the pandemic level has been reduced and healthcare with its associated education returns to normal. However, it is always important to measure the success of policy implementation and therefore e-learning activists should be considering now how the success of hastily implemented alternative teaching methods can be measured.

To achieve this, it might be useful to have a framework to measure success. There may naturally be those who argue that the implementation of such methods during disruption to normal teaching was not a success. However, this may be due to a failure to prepare staff or students adequately rather than a failure of the method itself. JISC (2008) discussed the tangible benefits of e-learning and the main themes are outlined in Box 1.


Box 1. Examples of tangible benefits

  • Cost savings/resource efficiency
  • Recruitment and retention
  • Skills and employability
  • Student achievement
  • Inclusion
  • Widening participation and social equity
  • Other benefits

Source: JISC (2008)


Cost savings

JISC (2008) suggested that the main cost savings are in relation to submitting and marking assessments online, particularly when there are large cohorts of students.

Some healthcare courses already have an element of online submission, but while this might be possible to implement in some HEIs in the next few months, there is the issue of staff downloading, marking and returning assessments online. This is an example of where policies on submitting assessments may need to be adapted in an emergency.

Preparation must also be considered, as not all staff may be ready for such a shift in emphasis in marking, especially as some teachers in healthcare education may still consider themselves to be “digital immigrants” rather than “digital natives” (Prensky, 2001).

However, the main resource efficiency is that, providing there is adequate preparation, teaching can continue. This has potential cost savings as once normal teaching resumes staff do not have to be paid overtime to have buildings open in the evenings or weekends so that ‘catch-up’ lectures can be delivered in traditional face to face settings.

Recruitment and retention

Although increasing numbers of applications are now made online, administrators still need to process them and this may be disrupted during potential or partial closure of HEIs.

When considering student retention, successful support has been given to non-traditional healthcare learners via HEIs’ e-portfolio system (JISC, 2008). This can be further developed by personal tutors for tutor groups, and by module leaders or even programme directors for specified groups of students. Specific students in placements can be similarly supported, either individually or in groups, for example in particular ward or clinic settings.

Skills and employability

JISC (2008) gave examples of how healthcare students have been supported to become independent and adaptable to the practice setting. However some of these may take too long to implement if teaching methods need to be changed quickly (and in situations such as these it is important to ensure the quality of teaching does not deteriorate).

However, case based scenarios (JISC, 2008) should be relatively easy to introduce quickly provided that teachers have the necessary skills in online facilitation (Salmon, 2003). This may also benefit qualified healthcare professionals carrying out post registration and postgraduate activity.

Students should be encouraged to record their professional development using their HEI’s e-portfolio tool and relevant HEI staff should be able to support them in this.

Student achievement

Using e-learning methods gives students the opportunity for formative assessment and timely feedback. Although on planned technology enhanced modules the assessment task(s) may be designed and validated to use technology during disruption to teaching, formative assessment may have to be used as a ‘bolt-on’ and therefore it would be difficult to make it compulsory for students.

However, teachers should ensure that students are aware of the benefits of formative assessment, how it can enhance learning and therefore student achievement.

Teachers who are accustomed to using technologies such as blogs as a bolt-on outside the classroom are likely to be called on by less experienced colleagues, not necessarily to use blogs but to share their experiences of giving feedback to ‘thinking out loud’.

Equally, those used to working in online communities will be aware of the process of e-moderating (Salmon, 2003) (different to moderation in the assessment process) and, again, will be able to help less experienced colleagues.


E-learning can provide opportunities for those who may find attendance and course participation at a traditional HEI challenging either because of mobility or learning issues.

However, alternative teaching methods should include and not exclude those who were able to achieve in a traditional face to face setting.

While students with specific learning difficulties such as dyslexia may prefer to listen to lectures in an audio format, not all students benefit from this learning technology, particularly those who are hearing impaired. For example, a lip reading student will have learnt to manage in a face to face setting by using strategies such as sitting in a place where s/he is able to lip read and may well have mentioned this to lecturers.

However, with teaching disruption, if teachers upload their PowerPoint presentations and also think to be helpful and give a ‘voice over’ or even use a technology such as Adobe presenter, it is possible that lip reading students may not be included unless a full script is also given as part of the presentation. 

Widening participation

While JISC (2008) gave examples of how e-learning can help in the planned widening participation of students, this may not be so important in any short term disruption to normal teaching. The report also suggested the concept of social equity. Here there is the suggestion that academics should foster students who are capable of independent, reflective and critical thinking about, and hence engagement with, wider society (JISC, 2008).

In any possible disruption to teaching, a skilled teacher should be able to use technology such as a VLE not only to upload lecture notes, but also to ask questions and present discussion starters at an appropriate academic level that helps to develop these skills.

Other benefits

There may be benefits for either students or teachers. A benefit for students may be that they are able to attend and participate in online discussions while still providing family care at home. Using different technologies may help to deepen learning, especially if they have the opportunity to listen or time to reflect in an asynchronous discussion before giving a response.

For teachers, preparation for such disruption may lead to their further professional development either in e-learning generally or in one specific aspect, such as using a particular technology. Alternatively, some teachers may be challenged to reflect on their methods of face to face teaching and consider different pedagogies for different aspects of their course.

Application to practice settings

While this article has so far considered using technology enhanced learning in classroom settings, consideration can also be given to supporting students who may remain in practice settings.

Although guidance has been given (NMC, 2009), students may receive less support from local link lecturers or practice education facilitators (PEF). Again, technology enhanced learning should be able to help and local initiatives may arise or current initiatives be further developed.

Hall et al (2000) described the use of technology to reach non healthcare students in diverse geographical settings. However, this was done using synchronous technology, and so may not be feasible in healthcare due to its 24/7 nature and the shift patterns that learners may work to ensure they are on placement with mentors. Asynchronous support can still be offered; this may be one way, two way between student and facilitator, or even multi way between the teacher and a group of students by using VLE discussion boards, e-portfolio blogs or a similar tool.

Using such technology should enable both teachers and PEFs to maintain most standards devised to support learning and assessment in practice (NMC, 2008). A separate evaluation of the achievement of these standards would be useful during the flu pandemic.


This article has sought to identify not only the reasons for but also how to implement healthcare education policy for swine flu preparation.

As well as implementing policy, it is also important to plan to measure its success. E-learning activists and those who lead such implementation have been called on to consider the ’measurement of success‘ stage, not only for the classroom, but also for the practice setting.

Careful use of findings may lead to further developments in e-learning and an attitudinal shift in approaches to this method.



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