Massive Open Online Course for Paps: An Electronic Educational Module Building Exercise to Train Cytoscreeners—Making Pap Smears Available in Resource-Limited Settings
Rajan Dewar, Gita Jayaram, Vinita Parkash, Indra Balachandran, Rosemary Tambouret · American Journal of Clinical Pathology · 2016
Objectives: Lack of cervical cancer screening in low- and middle-income countries (LMICs) causes an unacceptably high number of deaths among middle-aged women, which is expected to increase over the next several years. Pap smear-based cervical cancer screening has been eschewed by governmental agencies in these countries over visual inspection with acetic acid, claiming lack of resources or infrastructure to train cytoscreeners. Our own program has independently shown that cytology-based screening is not only possible, but also the best cost-effective strategy in LMICs such as India. In an effort to scale up our cytoscreener training and make it widely available, we propose to use a massive open online course (MOOC) platform for Pap smear training. Methods: The MOOC platform at the University of Michigan, offered through a collaboration with Harvard University’s EdX, and is called MichiganX. MichiganX has editing (studio.edge.edx), staging, and release platforms, which enables short video clips, presentations, files, and illustrations along with online tests that can be offered to the trainees. These clips or modules are typically 6 minutes long. Prior to the use of MichiganX, we created ∼20 lectures/modules in PowerPoint format, which covered topics, eg, the basics of cytology, biology of neoplasia, Bethesda classification. These will be broken down to create the MOOC modules. Results: Our current training, which includes a face-to-face lecture format as well as the use of electronic resources, showed an increase in Pap smear reading skills among newly trained lab technicians. By converting this to a MOOC platform, we plan to increase the availability of Pap smear training more widely. Conclusions: Electronic (internet-based) learning resources can be very useful in training cytoscreeners in LMICs, and should be pursued rigorously to make cytology-based cervical cancer screening available globally.