title: Self-directed e-learning at a tertiary hospital in Malawi--a qualitative evaluation and lessons learnt.
abstract: BACKGROUND
  Malawi faces a severe lack of health workers. Despite initiatives to address this problem, a critical shortage of health care staff remains. This lack challenges the education and training of junior medical staff, especially medical interns in their final and crucial training year before they independently work as medical doctors.
  
  
  METHODS
  We have introduced an e-learning platform in the medical department of the Kamuzu Central Hospital (KCH) in Malawi. With the support of computer-assisted instruction, we aimed to improve the quality of medical training and education, as well as access to current medical materials, in particular for interns.
  
  
  METHODS
  From March to April 2012, we conducted a qualitative evaluation to assess relevance and appropriateness of the e-learning platform. Data was collected via face-to-face interviews, a guided group discussion and a checklist based observation log. Evaluation data was recorded and coded using content analysis, interviewees were chosen via purposive sampling.
  
  
  RESULTS
  E-learning proved to be technically feasible in this setting. Users considered the e-learning platform to be relevant and appropriate. Concerns were raised about sustainability, accessibility and technical infrastructure, as well as limited involvement and responsibilities of Malawian partners. Interest in e-learning was high, yet, awareness of and knowledge about the e-learning platform among potential users was low. Evaluation results indicated that further adaptions to local needs are necessary to increase usage and accessibility.
  
  
  CONCLUSIONS
  Interview results and our project experiences showed that, in the given setting, e-learning requires commitment from local stakeholders, adequate technical infrastructure, identification and assignation of responsibilities, as well as specific adaption to local needs.
authors.affiliation: Heidelberg University, Institute of Public Health, Heidelberg, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Barteit
authors.affiliation: University Hospital of Würzburg, Clinic and Polyclinic for Psychiatry and Psychotherapy, Würzburg, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Hoepffner
authors.affiliation: University of Bern, Institute of Medical Education, Department of Assessment and Evaluation, Bern, Switzerland.
authors.forename: Sören
authors.initials: S
authors.lastname: Huwendiek
authors.affiliation: ESTHER Germany, Malawi German Networking for Capacity Building in Treatment, Training and Research at Kamuzu Central Hospital (MAGNET), Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Karamagi
authors.affiliation: Kamuzu Central Hospital, Medical Department, Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Munthali
authors.affiliation: ESTHER Germany, Malawi German Networking for Capacity Building in Treatment, Training and Research at Kamuzu Central Hospital (MAGNET), Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Theurer
authors.affiliation: Heidelberg University, Institute of Public Health, Heidelberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Neuhann
mesh_terms: D003194:Computer-Assisted Instruction / Q000379:methods*; D003479:Curriculum; D003906:Developing Countries; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D005240:Feasibility Studies; D007396:Internship and Residency / Q000458:organization & administration*; D008295:Malawi; D016544:Patient Simulation; D011380:Programmed Instructions as Topic; D062606:Tertiary Care Centers; D014584:User-Computer Interface
keywords: ICT; Medical Education; Sub-saharan Africa; capacity; computer-assisted instruction; multimedia; teaching hospital; understaffed; virtual patients