Dr. Sockalingam is professor and vice-chair education, Department of Psychiatry, University of Toronto, Faculty of Medicine; vice president education and clinician scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Ms. Rajaratnam is a research analyst, ECHO Ontario Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Zhou is a resident in Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Serhal is senior director of Outreach, Telemental Health and ECHO Ontario Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Crawford is an associate professor, Department of Psychiatry, University of Toronto, Faculty of Medicine; associate chief, Outreach and Telemental Health, Centre for Addiction and Mental Health, Toronto, Canada. Dr. Mylopoulos is an associate professor, scientist, and associate director of training programs, Wilson Centre and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
J Contin Educ Health Prof. 2021 Apr 1;41(2):104-110. doi: 10.1097/CEH.0000000000000349.
With the proliferation of virtual learning programs during the COVID-19 pandemic, there is increased need to understand learner experiences and impact on developing expertise. Project Extension for Community Healthcare Outcomes (Project ECHO®) is an established hub-and-spoke tele-education model aimed at building capacity and expertise in primary care providers. Our qualitative study explored how learning experiences within an ECHO mental health care program supported provider learning and ability to solve complex clinical problems.
We sampled ECHO sessions across a 34-week cycle and analyzed audio transcribed data. Two individuals coded participant interactions during 2-hour recorded sessions using an iterative, constant comparative methodology.
The authors identified four key mechanisms of learning in ECHO: (1) fostering participants' productive struggle with cases, (2) development of an integrated understanding, (3) collaborative reformulation of cases, and (4) generation of conceptual solutions based on a new understanding. Throughout the ECHO sessions, learning was observed to be multidirectional from both the hub-to-spoke and between spoke sites.
Despite the widespread implementation of Project ECHO and other virtual learning models, a paucity of research has focused on mechanisms of virtual learning within these models. Our study demonstrated a bidirectional exchange of knowledge between hub specialist teams and primary care provider spokes that aligned with the development of adaptive expertise through specific learning experiences in Project ECHO. Moreover, the ECHO structure may further support the development of adaptive expertise to better prepare participants to address patients' complex mental health needs.
在 COVID-19 大流行期间，虚拟学习计划激增，因此人们越来越需要了解学习者的体验及其对专业知识发展的影响。扩展社区医疗保健成果项目（ECHO®）是一种成熟的中心辐射型远程教育模式，旨在提高初级保健提供者的能力和专业水平。我们的定性研究探讨了 ECHO 心理健康护理项目中的学习经验如何支持提供者的学习并帮助他们解决复杂的临床问题。
我们在 34 周的周期内对 ECHO 会议进行了抽样，并分析了音频转录数据。两名研究人员使用迭代的、不断比较的方法对 2 小时记录会议中的参与者互动进行编码。
作者确定了 ECHO 中的四个关键学习机制：（1）促进参与者对案例的富有成效的挣扎，（2）发展综合理解，（3）协作性地重新表述案例，（4）基于新理解生成概念性解决方案。在整个 ECHO 会议中，学习被观察到是多向的，既来自中心辐射型的专家团队，也来自辐射型的初级保健提供者站点之间。
尽管 ECHO 项目和其他虚拟学习模式已经得到广泛实施，但很少有研究关注这些模式中的虚拟学习机制。我们的研究表明，中心专家团队和初级保健提供者之间存在知识的双向交流，这与通过 ECHO 中的特定学习经验发展适应性专业知识相一致。此外，ECHO 结构可能进一步支持适应性专业知识的发展，以更好地准备参与者满足患者复杂的心理健康需求。
