A model for design and development of online Health Professions Education Faculty Development Courses in sub-Saharan Africa

DOI: https://doi.org/10.21203/rs.3.rs-1807314/v1

Abstract

The design and development of faculty development courses require a theoretical base that is cognisant of contextual factors. The purpose of the study was to determine the feasibility of a specific conjecture map as a model for the design and development of online health professions education faculty development courses in sub-Saharan Africa through a heuristic evaluation approach. The authors hypothesise that using heuristic evaluation strengthens an educational model’s theoretical basis and feasibility.

Twenty-five health professions educators from nine sub-Saharan African countries participated in this multi-phased study. In the first phase, the participants completed a survey evaluating the model and the accompanying author-generated heuristics. Then, recommendations based on agreement from the participants were used to revise the model and the heuristics. In the subsequent phase, participants reviewed the revisions made and commented on the feasibility of the model within their local context.

All six heuristics were revised following the initial phase, where 80 problems had been identified. The model was revised based on the responses and re-presented to participants. The model was deemed feasible by all except one participant upon revision. There was a strong relationship and inter-rater agreement of feasibility between 0.84 and 0.95 in terms of practicality, demand, acceptability, and adaptability of the model. Revisions to the final model and guidance documents incorporated all changes recommended by the participants, confirming the feasibility of a model for the design and development of online health professions education faculty development courses in sub-Saharan Africa.

Theoretical models are often developed through a top-down approach which omits the practice-based considerations that could change the formulation of the model. This study demonstrates the convergence of a theoretical and process model with theoretical, expert and end-user data triangulation. Further research is needed to test this empirically developed model for designing and developing online health professions education faculty development courses in sub-Saharan Africa.

Background

Faculty development is inherently complex. The design and development of effective faculty development courses must adopt evidence-based approaches (1). Whether in person or online, faculty development courses in health professions education (HPE) aim to facilitate professional growth in teaching, leadership and management skills (2, 3). The evidence on the implementation and success of online faculty development courses for HPE in sub-Saharan Africa does not fully indicate the local geographical gaze (4) and omits contextually relevant factors, curricular, funding, and governance issues (5–8). The theoretical and contextual grounding of the design and development of online faculty development courses for HPE in sub-Saharan Africa has not received significant attention (1, 6) (5).

The design and development of online faculty development courses for HPE must consider contextual factors relevant to geographic location (9). However, the reality of these factors, including funding limitations, pressing health priorities and access, are not uniform across low- and middle-income countries (10). These contextual considerations imply that approaches to the design and development of faculty development courses for HPE should enhance the usability and feasibility of such courses (3, 11). Usability in the educational environment relates to the ability of the proposed system to support the learning process towards desired outcomes (12), while feasibility relates to the practicality of the proposed system within a context (13). Through the contributions of local experts and end-users in the design and development of these courses, a greater possibility exists of contextually relevant course structure, content and outcomes (14, 15).

Models for online learning have been developed, re-developed and designed over decades (16). All models must evolve from hypothetical structures (17) to specific structures that are feasible within contexts. The feasibility of implementing models within contexts requires clarity and alignment to context-specific issues such as funding decisions, curricular decisions and technology (6). While the authors are aware of the contextual implications for low-and-middle-income countries being strongly linked to developing a community of practice (6), the nuances in these implied geographical contexts are likely to be varied. Therefore, the design and development of models should embrace empirical evidence of the educational value in context to ensure that both researchers and faculty development practitioners can address the issues mentioned above (18).

Design-based research is one approach that promotes the achievement of theoretical and contextual relevance in educational model design and development to enhance usability and feasibility (19). Adopting this approach to model development ensures that the call to embed a scholarly approach to online faculty development courses for HPE is met (11, 15) and supports the feasibility of implementing the designed model in practice. Design-based research allows researchers to conduct empirical research in a naturalistic setting, emphasising local interpretation and context (20). In a practical sense, both expert and end-user inputs are incorporated in exploring the usability and feasibility of an artefact or model. Conjecture mapping is a design-based research method that acts as a conceptualisation mechanism for research, identifying the salient theoretical and design principles applicable to a particular learning environment and mapping the predicted outcomes to these principles (19). As per design-based research methodology, model development often includes end-user testing for feasibility prior to implementation (21).

Testing for feasibility, in this case, would require the presentation of a set of heuristics to educators who design and deliver online HPE faculty development courses (22). Heuristics are rules of thumb or principles that support the practical enactment of an artefact or a model. The heuristics in feasibility testing are generated by the designer of a model as a mechanism through which usability problems can be identified by the potential users of the model (23). The authors developed a set of heuristics and a conjecture map by following a modified Delphi method in a separate study as a precursor to this research (in press). In this study, a specifically designed conjecture map for the design and development of online faculty development for HPE is tested for usability and feasibility within the sub-Saharan Africa context.

The usability and feasibility of a model must be tested prior to implementation. The feasibility of a designed theoretical model requires the insight and experience of the potential end-users of the model, such as the health professions educators within the geographic region. The purpose of the study was to determine the usability and feasibility of a specific conjecture map as a model for the design and development of online HPE faculty development courses in sub-Saharan Africa.

Methods

This study was conducted in multiple phases, with this manuscript reporting on the final phase of the study. During the pre-study phase, the authors built a conjecture map hypothesising that the salient theoretical and design factors required for online HPE faculty development would be informed by the conversational framework (24) and community of inquiry (25). Three independent studies were conducted to develop the model for the design and development of online HPE faculty development courses. In the initial theory-building study, the authors conducted a rapid realist review testing the pre-designed conjecture map to identify the context, mechanism and outcomes of online faculty development for HPE in low and middle-income countries (6). Using the data from this review, the authors refined the map to reflect six triggering events identified from the results for positive outcomes of the faculty development courses. These six triggering events were programme type, programme design, discussion, engagement, development and collaboration; all reliant on the building of a community of practice underpinned by the community of inquiry framework (6).

Following the rapid realist review, the revised conjecture map was presented to nine experts in HPE based in sub-Saharan Africa through a modified Delphi study (in press). The expert panel reached consensus on the identified components of the map and suggested refinement on aspects related to the design and delivery of online HPE faculty development courses. Findings from this study showed that specific curricular, research, environmental and learning activity types were the components required for the successful design and delivery of online HPE faculty development courses. This modified Delphi study informed further adaptation of the map. The final conjecture map was prepared as a process model alongside a set of heuristics that combine theory and practice-based information as opposed to an exclusively theoretical model (26).

Design

An adaptation of the process model of the participatory heuristic evaluation approach (23) was applied to explore the usability and, subsequently, the feasibility of the model developed for the design and development of an online HPE faculty development courses in sub-Saharan Africa. Traditionally, heuristic evaluations are utilised in software development (22). However, using this approach, the product designers elicit feedback from experts and representative end-users on potential usability problems through independent and collective interactions with the software and designers, respectively (23, 27). Therefore, the heuristic evaluation was adapted to a model within this study instead of a software product. Additionally, as experts had been included in the preceding modified Delphi study, this heuristic evaluation elicited input from the representatives of the HPE community who are likely to use the model in their context. Therefore, it is posited that the participants were ideally positioned to provide relevant and contextual input prior to the dissemination and implementation of the model being promoted.

Study population

The authors received gatekeeper permission to contact members of a non-profit organisation that focuses on capacity building in the field of HPE. The members of this organisation are health professions educators in sub-Saharan Africa who have completed a fellowship in HPE and leadership (28). These members were representative of the end-users of the proposed model. Two hundred and nineteen members were contacted via email to request participation in the study. Thirty affirmative responses were received.

The authors reviewed the participant list to ensure diversity in regional distribution across sub-Saharan Africa. An additional four participants who were not part of the non-profit organisation, but were experienced and working in the field of HPE, were identified through snowball sampling. These participants represented an underrepresented region in sub-Saharan Africa among the original participant population. Finally, three participants who consented to participate in the study were excluded based on their classification as experts during the preceding phases of this research; thus not the end-users targeted in this study.

Data Collection

Study data were collected and managed using REDCap electronic data capture tools hosted at the University of the Free State (29, 30). The participants provided informed consent for participation in this ethics approved study (UFS-HSD2020/1516/2411). Data were collected in two phases. In phase one, demographic data related to age, gender, number of years as an educator, country of residence and professional position was collected for each participant. In addition, participants were instructed to review the conjecture map as a model (Fig. 1) alongside a set of heuristics with indicators and guiding questions in relation to their local context.

The heuristics were developed based on the findings of the modified Delphi study completed in the initial phase, foregrounding the expert opinion from sub-Saharan Africa. The heuristics set for this model were as follows:

  1. Systems should be in place to support the sustainability of Online Faculty Development.

    2.

  2. Tools should be simple, open-access and facilitate discussion.

    3.

  3. Activities should facilitate engagement and building a Community of Practice.

    4.

  4. Characteristics of facilitators should be carefully identified to ensure that clinicians and educators are supported.

    5.

  5. Course design should include planning for evaluation research into the success of the intervention.

    6.

  6. The Online Faculty Development Programme should have measurable outputs related to Professional and Personal Development.

    7.

For each heuristic, participants were asked to confirm the relevance and clarity of the statement provided about the model. Participants were further asked to indicate their agreement with the indicators and guiding questions or make recommendations for changes.

In phase two, participants were asked to confirm or deny the feasibility of the model for the design and development of an online HPE faculty development course in their context in terms of adaptability, demand, acceptability and practicality (31). The original and changed model was distributed via an online shared document, and the participants were provided with a detailed explanation of how the changes were made to the heuristics and model. Each participant was instructed to indicate whether they agreed, disagreed or were unsure of the feasibility of the model and revised heuristics.

Data Analysis

Following the first phase of data collection, the first author reviewed the responses and analysed the number of areas of concern identified by the participants. The analysis was done per country, per heuristic and geographical region. Next, the authors revised all six heuristics for online faculty development courses for health professions educators using the recommendations provided by the participants. This revision combined all indicators with the heuristics and refined the guiding questions provided to participants in phase one. Furthermore, changes to the model were made based on the evaluation from participants to ensure that non-applicable components were omitted.

In phase two, the revised heuristics and model were presented to the participants in a follow-up survey to determine feasibility within their contexts. A custom-designed scoresheet was used to analyse the level of agreement for each type of feasibility. Agreement was allocated a score of 2, with uncertainty given a score of 1. The highest score possible for each feasibility question per participant was 8. In addition, scores were analysed for inter-rater agreement and feasibility categories compared for correlation to the category with the lowest inter-rater agreement (32). Finally, the authors analysed the results of the feasibility survey to generate the final model for the design and development of online HPE faculty development courses in sub-Saharan Africa.

Results

Two hundred twenty-three invitations were sent for participation in the study, which achieved a response rate of 11.2% (n = 25). Distribution by geographic region enabled representation across the participants from all sub-Saharan African regions. Participant representation and demographic data identified nine countries and nine professional disciplines with an average of 16 years of experience as an educator.

Participants were able to identify usability problems in five areas: relevance to their context, clarity, formulation of the heuristic, indicators, and guiding questions. The participants identified 80 problems indicated in red or blue for each record. Green indicates no problems identified. Colour indicators in the total column refer to the presence of problems for each heuristic in successive order. (Table 1). The heuristic related to characteristics of the facilitator and participant was identified as the one with the most usability problems.

Heuristics and indicators were combined, and guiding questions were revised based on the feedback from participants (Additional file 1).

Changes to the model reflected the qualitative recommendations and comments by participants. (Fig. 2)

Feasibility was measured in terms of acceptability, adaptability, demand, and practicality (31). Invitations to complete the feasibility round of the survey were sent to the twenty-five participants who had participated in round 1. A response rate of 76% (n = 19) was achieved. Representation in the responses included eight countries in sub-Saharan Africa and seven professional disciplines. The model was deemed feasible by participants in seven countries and six professional disciplines where feasibility scores demonstrated agreement and a high inter-rater agreement.

The data shows a high level of inter-rater agreement across all participants for all categories, with the lowest being Practicality at 0.84 (Table 2).  

Table 2

Inter-rater agreement

Acceptability

Demand

Practicality

Adaptability

0.95

0.95

0.84

0.92

Demand and Practicality categories demonstrate a strong positive relationship, with Acceptability and Adaptability showing a very strong positive relationship between these categories and demand (Table 3) (33).  

Table 3

Relationship between categories

Feasibility Categories

Acceptability and Practicality

Demand and Practicality

Adaptability and Practicality

Pearson’s r

0.70

0.41

0.77


Upon conclusion of the data analysis, the authors were able to adjust the model, albeit limited to minor adaptations (Fig. 3). Relational arrows were added to indicate the relationship between the design and theoretical conjectures set within this model (Fig. 4).

The heuristics deemed usable and feasible by the participants, Systems, Technology, Activities, Characteristics, Evaluation and Outcomes (STACEO), provide the inception point for the administration, design, implementation, and evaluation of online HPE faculty development courses using scholarly approaches (Table 4).

Table 4 

STACEO Rules for online health professions faculty development courses




Discussion

Theoretical models are often developed through a top-down approach, omitting the practice-based considerations that could change the formulation of the model (26). This study demonstrates the convergence of a theoretical and process model with the triangulation of theoretical, expert and end-user data in determining the usability and feasibility of a model. The varied experience and expertise across disciplines, within and across countries, support the finding of the feasibility of the model within this convergence of evidence. With a combined average of 16 years of experience in HPE, the authors contend that the participants’ responses are supported by their experience within their roles and scholarly efforts to develop their skills in HPE faculty development (14). Furthermore, these participants' experience within higher education ensures their understanding of their own context, whether on the ground level or in management positions, thus providing contextual reference points for them in engaging with the model.

Online faculty development for HPE requires evidence to ensure sustainability and efficacy to support the development of skills in research, teaching, leadership and administration (1, 3, 5). However, the current literature highlights the lack of contextualised approaches to this practice, particularly in low and middle-income countries (6). The context in the development of online learning opportunities matters (11, 14, 15, 34), and by extension, in the development of online faculty development courses. The literature currently presents evidence for the design of faculty development courses from predominantly high-income country funded courses (5, 6). More specifically, the literature presents the experience of the recipients of these courses from the perspective of a foreign or external stakeholder, that is, a foreign gaze (4). Often, this gaze is further removed from the recipients as it is the gaze of the funder or provider of the course (35, 36). By presenting a user-friendly and feasible model for sub-Saharan Africa, the authors contribute to the discourse on the evidence for the design and development of online faculty development courses for health professions educators.

Adaptation of standard heuristics for suitability to a specific discipline is encouraged within the field of e-learning (27) and, to our knowledge, has not been adopted within the field of model development in faculty development or online faculty development. Therefore, the authors have presented a novel approach that could be included in the development of faculty development models, not just as a design-based research methodology (21), but for the scholarly advancement of faculty development. Through the positive findings of this study and the resultant model, the goal of the heuristic evaluation was achieved (37). That is a usable and adaptable model within the intended context of HPE in sub-Saharan Africa (22, 23, 37, 38).

The model's policy and structural features had the highest number of identified problems. This outcome resonates with previous research on the feasibility of educational models for online learning (1, 11, 39, 40). Surprisingly, the identified problems were related to the semantics or combination of the guiding questions, as opposed to the constructs as would have been expected in a traditional heuristic evaluation (23). The authors propose that this outcome is indicative of the rigour with which the model and heuristics had been developed, thus meeting the need for a model that is usable by the participants, albeit with minor adaptations. Furthermore, the absence of outright changes to the presented model demonstrates the internal validity of the expert input during the preceding phase of this research (26). This alignment between experts and end-users, while not unprecedented, demonstrates a unique occurrence in heuristic evaluation (38).

Regarding the systems and tools, the participants highlighted issues related to systemic or institutional responsibilities for infrastructure and embedded organisational practice in the form of committees and high-level support. This again raises the issue of limited local resources available to create these supportive resources and systems in sub-Saharan Africa (1, 5, 9, 14). Regarding technology, the model and heuristics presented initially referred to open-source software. However, the participants' contributions echoed that of international research in that open-source software is not a requirement if user-friendly, engaging software options are available within the organisation presenting the course (1, 6, 41, 42). The assertion of this critical systemic support by participants should be noted by administrators and leaders of institutions in strategic planning and support. Ensuring that systems and support structures are in place should be read as a non-negotiable within this model for online HPE faculty development courses in sub-Saharan Africa.

Online HPE faculty development courses in sub-Saharan Africa should include case studies, discussion-based activities, and the submission of a portfolio of evidence. Though not specific regarding content within the model, these course activities do require that facilitators are competent in either the process of online learning or the subject matter. Including this component in the presented model aligns with the findings from the literature that a combination or variation of facilitator competencies is required in online faculty development courses (1, 6, 35, 43, 44). As such, activities prepared by these facilitators should remain focused and aligned with the outcomes set during the development of a course. The focus could be related to professional growth and innovation in teaching, management, leadership or research skills (11, 40, 45).

The characteristics of facilitators and course participants yielded the highest number of identified problems. This was dominated by identifying a required semantic change, eliminating the separation of clinical and health professions educators within the heuristic. More importantly, the problems identified across the panel for this construct were related to the need for well-trained facilitators, process experts, health professions educators, and disciplinary experts. While appearing to be problem identification, this finding supports the model as it is developed based on the components within the Community of Inquiry (25). The teaching presence facilitated by these trained facilitators ensures targeted and engaged learning (46), mainly when constructive feedback is provided through discursive practice prioritisation (6).

Online HPE faculty development studies have focused on participant experience and organisational expectations for the outcome of courses (1). However, in this study, participants did not focus on the recipients of an online faculty development course; instead, the focus was on facilitator roles and supportive structures. Again, this finding speaks to the importance of teaching presence as an influential factor in the effective delivery of online learning environments for faculty development. Therefore, these online courses should focus on the structure and process of an educational experience and setting the climate through an overlap of the teaching and social presence (46–49) in the facilitators’ role of creating a community of practice.

There were no disagreements on the feasibility of the model across seven countries in sub-Saharan Africa and six professional disciplines. While the question may be raised as to whether the lack of country diversity in the presence of regional diversity plays a role, we contend, as do others (50), that individual country differences will be minimal within the sub-Saharan African region. Additionally, the volunteer nature of participants whose experience in an HPE fellowship could influence their responses could contribute to this level of agreement. This should, however, be further investigated through the application of the model to a specific course within a particular country. Additional feasibility testing using a granular approach across larger representative samples should investigate the model on specific courses in specific countries in SSA. It would be prudent to highlight the local gaze within the recommended research concerning funding, policy, and other institutional structures (1,40,51).

While the novel collection of this data contributes to future practice, the authors recognise the limitation of a small number of participants, predominantly situated in anglophone Southern Africa, as a threat to usability across sub-Saharan Africa. Nevertheless, the nature of the findings, limited variance in inter-rater agreement, and the preceding phases of this study; demonstrate the scholarly approach taken using a representative sample of the population.

Conclusion

The methods used in this study and preceding phases demonstrate the rigour with which the authors recommend model development to be approached. Within any model development, just as with the development of an educational intervention, there exists a possibility that the hypothesis is wrong (16, 20). In the initial phases, the authors demonstrated the importance of exploring the literature in designing an online faculty development course and further established the findings’ authenticity from the literature through expert review from the local context. Finally, prior to dissemination, the authors sought to determine its’ feasibility through representatives of the recipients of the model in sub-Saharan Africa. The authors have empirically tested this particular model in its development and delivered a model that may be used in the future as a practical guide for educators who wish to develop online faculty development courses. This study, therefore, provides health professions educators and faculty development practitioners from sub-Saharan Africa with a theoretically grounded model for Online HPE faculty development courses that are contextually relevant, usable, and feasible.

Declarations

Authors' contributions:

LK, CN and CVW designed the study. LK adopted the lead role in data collection and analysis. CN and CVW contributed to the analysis of the data to reach the presented conclusions. All authors contributed to the drafting of the manuscript.

Acknowledgements

The authors wish to acknowledge the health professions educators who offered their valuable time to participate in this study. Dr Davidse and Mr Botha for their invaluable input as critical readers, and Dr du Preez for his editing services in the preparation of this manuscript.

 

References

  1. Cook DA, Steinert Y. Online learning for faculty development: A review of the literature. Med Teach. 2013;35(11):930–7.
  2. Van Wyk C, Nel MM, Van Zyl GJ. Practise what you teach: Lessons learnt by newly appointed lecturers in medical education. African J Heal Prof Educ. 2019;11(2):47.
  3. Steinert Y. Faculty development in the new millennium: key challenges and future directions. Med Teach [Internet]. 2000 Jan;22(1):44–50. Available from: http://informahealthcare.com/doi/abs/10.1080/01421590078814%5Cnfiles/759/01421590078814.html
  4. Abimbola S. The foreign gaze: Authorship in academic global health. BMJ Glob Heal. 2019;4(5):1–5.
  5. Barteit S, Jahn A, Banda SS, Bärnighausen T, Bowa A, Chileshe G, et al. E-learning for medical education in sub-Saharan Africa and low-resource settings: Viewpoint. J Med Internet Res. 2019;21(1).
  6. Keiller L, Nyoni C, van Wyk C. Online Faculty Development in low-and middle-income countries for Health Professions Educators: A rapid realist review. Hum Resour Health [Internet]. 2022;20(12):1–23. Available from: https://doi.org/10.21203/rs.3.rs-428797/v2
  7. Frantz JM, Bezuidenhout J, Burch VC, Mthembu S, Rowe M, Tan C, et al. The impact of a faculty development programme for health professions educators in sub-Saharan Africa: An archival study. BMC Med Educ. 2015;15(1):1–9.
  8. Bilal, Guraya SY, Chen S. The impact and effectiveness of faculty development program in fostering the faculty’s knowledge, skills, and professional competence: A systematic review and meta-analysis. Saudi J Biol Sci [Internet]. 2019;26(4):688–97. Available from: https://doi.org/10.1016/j.sjbs.2017.10.024
  9. Barteit S, Guzek D, Jahn A, Bärnighausen T, Jorge MM, Neuhann F. Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review. Comput Educ. 2020;145(September 2018).
  10. Uleanya C, Ke Y. Review of Preparedness of Rural African Communities Nexus Formal Education in the Fourth Industrial Revolution. South African Rev Sociol. 2019;50(3–4):91–103.
  11. Steinert Y. Perspectives on faculty development: aiming for 6/6 by 2020. Perspect Med Educ. 2012;1(1):31–42.
  12. Tsiatsos T, Andreas K, Pomportsis A. Evaluation framework for collaborative educational virtual environments. Educ Technol Soc. 2010;13(2):65–77.
  13. Orsmond GI, Cohn ES. The distinctive features of a feasibility study: Objectives and guiding questions. OTJR Occup Particip Heal. 2015;35(3):169–77.
  14. Frantz J, Rhoda A, Murdoch-Eaton DB, Sandars J, Marshall M, Burch VC. Understanding faculty development as capacity development: A case study from South Africa. African J Heal Prof Educ [Internet]. 2019;11(2):53. Available from: http://www.ajhpe.org.za/index.php/ajhpe/article/view/1026
  15. Lewis LD, Steinert Y. How Culture Is Understood in Faculty Development in the Health Professions: A Scoping Review. Acad Med. 2020;95(2):310–9.
  16. Mehlenbacher B. Models of Instruction and Learning with Technology. In: Instruction and Technology Designs for Everyday Learning. Cambridge, Massacheusetts: MIT Press; 2010. p. 109–58.
  17. Keeves JP. Educational research, methodology and measurement : an international handbook. 1st ed. Keeves JP, editor. Oxford: Pergamon; 1988. (Advances in education).
  18. Reeves TC, Lin L. The research we have is not the research we need. Educ Technol Res Dev [Internet]. 2020;68(4):1991–2001. Available from: https://doi.org/10.1007/s11423-020-09811-3
  19. Sandoval W. Conjecture Mapping: An Approach to Systematic Educational Design Research. J Learn Sci. 2014;23(1):18–36.
  20. Dix KL. DBRIEF: A research paradigm for ICT adoption. Int Educ J. 2007;8(2):113–24.
  21. Lee J, Lim C, Kim H. Development of an instructional design model for flipped learning in higher education. 2017;427–53.
  22. Nielsen J. How to Conduct a Usability Heuristic Evaluation. DesignModo [Internet]. 2014;1–8. Available from: http://designmodo.com/usability-heuristic-evaluation/
  23. Muller MJ, Matheson L, Page C, Gallup R. Methods & tools: participatory heuristic evaluation. Interactions. 1998;5(5):13–8.
  24. Laurillard D. Teaching as a Design Science: Building Pedagogical patterns for learning and technology. London: Routledge. London, UK: Routeledge Farmer; 2012.
  25. Garrison DR, Akyol Z. The Community of Inquiry Theoretical Framework. Handb Distance Educ. 2015;(11237).
  26. Lee J, Jang S. A methodological framework for instructional design model development: Critical dimensions and synthesized procedures. Educ Technol Res Dev. 2014;62(6):743–65.
  27. Reeves TC, Benson L, Elliott D, Grant M, Holschuh D, Kim B, et al. Usability and Instructional Design Heuristics for E-Learning Evaluation Usability and Instructional Design Heuristics for E-Learning Evaluation. 2002;(May 2014).
  28. Frantz JM, Bezuidenhout J, Burch VC, Mthembu S, Rowe M, Tan C, et al. The impact of a faculty development programme for health professions educators in sub-Saharan Africa: An archival study. BMC Med Educ. 2015;15(1):1–8.
  29. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. Vol. 95, Journal of Biomedical Informatics. 2019.
  30. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
  31. Bowen DJ, Kreuter M, Spring B, Linnan L, Weiner D, Bakken S, et al. NIH Public Access: how to design feasibility study. Am J Prev Med. 2010;36(5):452–7.
  32. Shweta, Bajpai RC, Chaturvedi HK. Evaluation of inter-rater agreement and inter-rater reliability for observational data: An overview of concepts and methods. J Indian Acad Appl Psychol. 2015;41(Special Issue 3):20–7.
  33. Al-Osail AM, Al-Sheikh MH, Al-Osail EM, Al-Ghamdi MA, Al-Hawas AM, Al-Bahussain AS, et al. Is Cronbach’s alpha sufficient for assessing the reliability of the OSCE for an internal medicine course? BMC Res Notes. 2015;8(1):4–9.
  34. Brown JC, Crippen KJ. Designing for culturally responsive science education through professional development. Int J Sci Educ [Internet]. 2016;38(3):470–92. Available from: http://dx.doi.org/10.1080/09500693.2015.1136756
  35. Anshu, Sharma M, Burdick WP, Singh T. Group dynamics and social interaction in a south asian online learning forum for faculty development of medical teachers. Educ Heal Chang Learn Pract. 2010;23(1):1–9.
  36. Dongre AR, Chacko T V., Banu S, Bhandary S, Sahasrabudhe RA, Philip S, et al. On-line capacity-building program on “Analysis of Data” for medical educators in the South Asia region: A qualitative exploration of our experience. Educ Heal Chang Learn Pract. 2010;23(3).
  37. González M, Masip L, Granollers A, Oliva M. Quantitative analysis in a heuristic evaluation experiment. Adv Eng Softw [Internet]. 2009;40(12):1271–8. Available from: http://dx.doi.org/10.1016/j.advengsoft.2009.01.027
  38. York CS, Ertmer PA. Extracting Heuristics from Expert Instructional Designers. In: Proceedings ofthe Association for Educational Communications and Technology. 2009. p. 496–510.
  39. Cilliers FJ, Tekian A. Effective Faculty Development in an Institutional Context: Designing for Transfer. J Grad Med Educ. 2016;8(2):145–9.
  40. Tekian A, Harden RM, Cook DA, Steinert Y, Hunt D, Norcini J. Managing the tension: From innovation to application in health professions education. Med Teach [Internet]. 2019;0(0):1–7. Available from: https://doi.org/10.1080/0142159X.2019.1687871
  41. Brown J, Crippen K. Designing for culturally responsive science education through professional development. Int J Sci Educ. 2016;38(3):47--492.
  42. Vovides Y, Chale SB, Gadhula R, Kebaetse MB, Nigussie NA, Suleman F, et al. A Systems approach to implementation of elearning in medical education: Five MEPI Schools’ Journeys. Acad Med. 2014;89(8 SUPPL.):102–6.
  43. Ahmed S. Tailoring online faculty development programmes: overcoming faculty resistance. Med Educ. 2013;47(5):535.
  44. Abigail LKM. Do communities of practice enhance faculty development? Heal Prof Educ [Internet]. 2016;2(2):61–74. Available from: http://dx.doi.org/10.1016/j.hpe.2016.08.004
  45. Van Wyk C, Van Zyl GJ. The roles of the academic in health sciences: where to start from a faculty development perspective. Prof Dev Educ [Internet]. 2020;00(00):1–11. Available from: https://doi.org/10.1080/19415257.2020.1850506
  46. Garrison DR, Arbaugh JB. Researching the community of inquiry framework: Review, issues, and future directions. Internet High Educ. 2007;10(3):157–72.
  47. Garrison DR, Anderson T, Archer W. The first decade of the community of inquiry framework: A retrospective. Internet High Educ [Internet]. 2010;13(1–2):5–9. Available from: http://dx.doi.org/10.1016/j.iheduc.2009.10.003
  48. Stodel EJ, Thompson TL, MacDonald CJ. Learners’ perspectives on what is missing from online learning: Interpretations through the community of inquiry framework. Int Rev Res Open Distance Learn [Internet]. 2006;7(3):1–24. Available from: http://www.irrodl.org/index.php/irrodl/article/viewArticle/325
  49. Kear K. Social presence in online learning communities. 2010;541–8.
  50. Bvumbwe T, Mtshali N. Nursing education challenges and solutions in Sub Saharan Africa: An integrative review. BMC Nurs. 2018;17(1):1–11.
  51. Adefuye AO, Adeola HA, Bezuidenhout J. Medical education units: A necessity for quality assurance in health professions education in Nigeria. African J Heal Prof Educ. 2018;10(1):5.

Table

Table 1 is available in the Supplementary Files section