How do you capture the essence of compassionate care and the patient experience in an online environment? How do you engage global participants in communication and palliative care skill-building? How might you track these changes in professional practice? Ask Kavitha Ramchandran, MD (clinical assistant professor, Oncology) and Erika Tribett, MPH (program designer). Together they developed an online course in palliative care—Palliative Care Always—that is answering these questions with an audience of 1250 participants around the world.

“This process was a learning experience for us both,” says Ramchandran. “Erika has training in the health educational space. I work in medical oncology. We also gained a lot of information from Stanford University folks in education and online learning to ensure that all of the pieces were at the highest level prior to launch.” Tapping into the expertise of other groups across Stanford was critical, Tribett says. “We partnered with the Vice Provost of Teaching and Learning to develop the online platform component. They provided end-to-end support in instructional design, video production, and course evaluation.

“We were expecting,” she continued, “based on our level of promotion for the course, to work with around 500 participants for the first iteration. In the first month of enrollment, however, we reached 800 to 900 registrants. In the end we enrolled around 1250 participants, 2/3s of them clinicians, 1/3 of them patients, family members, or volunteers in the hospice space. We have huge diversity in terms of educational and geographic background. Participation is about 57% US, but we also see folks from India, Canada, Brazil, and over 80 other countries.”

“We created this course with the goal of recreating what palliative care should really be about,” Ramchandran explains, “which is a multidisciplinary environment that is meant to care for patients and whoever they consider part of their care team. We intended for a broad audience including chaplains, social workers, nurses, physicians, and advance practice providers. We were hoping to have input from patients and family members or people who’ve confronted serious illness and have interacted with the health care system. And that’s what we actually ended up with.”

Ten faculty members teach the course, each focusing on a specific role in interdisciplinary care—from medical oncologist and palliative care physician to social worker, chaplain, and survivorship nurse and more. They present topics in palliative care and communication skills via filmed scenes with a fictional patient, Sarah Foster, and didactic lectures that reflect on these scenes. The course has 12 modules, which tell a story based on the experience of Sarah Foster who is presented with the news of a colon cancer diagnosis. They also interact with participants using live video or a secure online chat room. Tribett explains how that works: “We’ve approximated live interactions with students using a live chat room and a platform called Talkabout that harnesses the technology of Google Hangouts to randomly generate small groups of six or seven student participants and faculty members. They can have a live video session using a discussion guide.”

Each module requires between 1 and 2 hours to complete. At the beginning of every module is a reading or a short video followed by a reflection prompt to which participants post responses on the course discussion forum.

Six modules have been modified for CME credit. Interactive sessions were removed to shorten the CME version to 30 minutes to one hour per module. Tribett explains that participants “will still be required to complete the lectures and the case study videos with the standardized patient and all of the assessment questions.”

Feedback is a critical part of a complete learning experience, both for students to express their opinions and for the course team to improve their content. Tribett discusses how they are gathering students’ opinions. “The standard ways include a pre-assessment for the online platform specific to our course content, and a follow-up post-assessment that is being sent out as soon as the course ends. We post questions and insights and a discussion thread on the forum each week as well as the reflections from participants that are required as part of course completion. In the future, we are looking towards using video role play with faculty as a practical assessment method, as well as peer feedback to demonstrate skill-building in the professional environment.”

Now that the first launch of Palliative Care Always is nearly complete, Ramchandran discusses some ideas for keeping this diverse global community vibrant. “We’re thinking about using social media to keep people engaged after course completion: a way for them to discuss how this has impacted them and a chance for them to continue to connect with this community. We are also looking at creating an impact survey so that we can follow people’s practice over time, probably at 6 months and a year, and see if they are able to use any of the skills they learned or if they change their practice.”

It is not surprising to learn that others at Stanford and elsewhere are interested in using the course. “I’m getting interest from different groups of learners at Stanford,” Ramchandran says. “They might use it for the care navigators that Stanford is hiring to help patients get through the system. The division chief and fellowship director are thinking of requiring it for all of the oncology fellows, who must have palliative care educational credit. It was already required of all advance practice nurses in oncology.”

Speaking about the interest beyond Stanford, she continues: “Others have talked about helping people from resource-poor places like parts of Africa and India that don’t have access to good palliative care training. We would modify the course to be more culturally appropriate and also think about how students could access online tools in resource-limited settings.”

Although they came at this course with different areas of expertise and from different points of view, the takeaways for Ramchandran and Tribett from the experience of building and launching the course are pretty similar.

“What was profound to me,” says Ramchandran, “was the excitement of a global connection around a shared common experience; thinking about health and wellness and living with dying; connecting with people around the world, having your stories heard, and feeling that there are people who want to share it. That was something I didn’t expect from this experience.”

For Tribett, who moderated the course week after week, it was all about the human element: “From listening to the discussion forums and watching people’s reactions in group discussions, it comes down to creating time and space to listen to one another’s stories, creating a health care system that allows for and incentivizes that. It all boils down to the patient saying ‘I want to be heard; I have my own sense of identity and I want to keep it; I need communication and I need support.’ This course brings everyone together around those common themes. It’s important to build opportunities to remind people that that’s what health care is about.”