Kitty
Senior Member (Voting Rights)
Both right. Associate professor of cardiometabolic health at University of Exeter Medical School.
NHS England - E-learning Modules on ME/CFS
- Thread starter John Mac
- Start date
Both right. Associate professor of cardiometabolic health at University of Exeter Medical School.
Elara Grey
Established Member (Voting Rights)
With regards to the format:
Certificates for the e-learning are only issued if each and every thing that has to be clicked on or answered, has been. It's designed this way so that people (in theory) can't just open it, press play on a video and walk away without watching it, or open an article without reading it.
There's so much mandatory e-learning every year that the majority hate it. It's also very repetitive, having to repeat the same modules at certain timeframes e.g. annually or every two or three years.
It has been known for people to do as described above, without paying an ounce of attention to the content. Often leaving the e-learning video playing while muted and they're doing something else entirely. Just to get the certificate checked off.
There's only so much interest they can muster up in forcing people to click and tick boxes on e.g. which fire extinguishers do what every year and how not to burn the place down by plugging in daisy chains of extension cords. Or by overloading the sockets. Or to avoid blocking fire escapes. Or to mop up spills so people don't slip.
This kind of formatting is designed to force the learner to at least be present and actually looking at the screen, to some extent. It tracks the learner's 'progress', often matching it against timing. So that if you just click on everything within a few minutes without reading it, the certificate isn't issued.
It's not infallible either. As others say, this still makes for people hardly paying much attention and easily forgetting everything later.
So, I'm not defending the formatting just explaining why it is the way it is.
And yes, I agree with this sentiment:
But, in reality, it's far more an extensive issue than hiring the right people. It would need an entire overhaul of the entire system. To start with, sorting out endless mandatory e-learning about countless modules of little importance/substance. But mostly ensuring the system has the funding, staffing levels, resources and culture to not burn out their entire staff in bureaucracy and endless paperwork and checkbox exercises instead of patient care.
All this is also partly why there has been so little uptake on the e-learning. People have to spend around an entire working week's worth of hours on mandatory e-learning. On topics incredibly mundane that it's actually painful sitting through it. Not many want to go out looking for extra to do - especially when they've still got their jobs to do and usually have to find additional hours to do said mandatory e-learning.
And at the same time, I don't mean to dishearten everyone with the above explanation.
By NHS standards, this is actually one of the most well put-together and interesting e-learning modules available. It is a far higher standard and more 'catchy' (attention-wise) than their usual stuff. Even though, yes, it is still delivered as though it's to:
And, regardless of the NHS generally otherwise producing e-learning so painfully boring to sit through, this is still a massive achievement from a system so disinterested in ME/CFS, even with the current flaws in it.
Overall, I thought the content was generally good, though I do share the critique already raised. Much of the content is a vast improvement on what the majority of NHS workers think, even though it could be better.
If I could choose one thing to remove as utmost importance, it would definitely be the link to BACME.
Hopefully (or maybe wishful thinking), further feedback will lead to the flaws being fixed. We've got to start somewhere.
Doing this type of thing with different things to click on to progress through and multiple choice questions to answer is typical of the NHS. Almost all e-learning has similar styles, and it's to 'make sure' people actually complete the whole thing.
Certificates for the e-learning are only issued if each and every thing that has to be clicked on or answered, has been. It's designed this way so that people (in theory) can't just open it, press play on a video and walk away without watching it, or open an article without reading it.
There's so much mandatory e-learning every year that the majority hate it. It's also very repetitive, having to repeat the same modules at certain timeframes e.g. annually or every two or three years.
It has been known for people to do as described above, without paying an ounce of attention to the content. Often leaving the e-learning video playing while muted and they're doing something else entirely. Just to get the certificate checked off.
There's only so much interest they can muster up in forcing people to click and tick boxes on e.g. which fire extinguishers do what every year and how not to burn the place down by plugging in daisy chains of extension cords. Or by overloading the sockets. Or to avoid blocking fire escapes. Or to mop up spills so people don't slip.
This kind of formatting is designed to force the learner to at least be present and actually looking at the screen, to some extent. It tracks the learner's 'progress', often matching it against timing. So that if you just click on everything within a few minutes without reading it, the certificate isn't issued.
It's not infallible either. As others say, this still makes for people hardly paying much attention and easily forgetting everything later.
So, I'm not defending the formatting just explaining why it is the way it is.
And yes, I agree with this sentiment:
But, in reality, it's far more an extensive issue than hiring the right people. It would need an entire overhaul of the entire system. To start with, sorting out endless mandatory e-learning about countless modules of little importance/substance. But mostly ensuring the system has the funding, staffing levels, resources and culture to not burn out their entire staff in bureaucracy and endless paperwork and checkbox exercises instead of patient care.
All this is also partly why there has been so little uptake on the e-learning. People have to spend around an entire working week's worth of hours on mandatory e-learning. On topics incredibly mundane that it's actually painful sitting through it. Not many want to go out looking for extra to do - especially when they've still got their jobs to do and usually have to find additional hours to do said mandatory e-learning.
And at the same time, I don't mean to dishearten everyone with the above explanation.
By NHS standards, this is actually one of the most well put-together and interesting e-learning modules available. It is a far higher standard and more 'catchy' (attention-wise) than their usual stuff. Even though, yes, it is still delivered as though it's to:
And, regardless of the NHS generally otherwise producing e-learning so painfully boring to sit through, this is still a massive achievement from a system so disinterested in ME/CFS, even with the current flaws in it.
Overall, I thought the content was generally good, though I do share the critique already raised. Much of the content is a vast improvement on what the majority of NHS workers think, even though it could be better.
If I could choose one thing to remove as utmost importance, it would definitely be the link to BACME.
Hopefully (or maybe wishful thinking), further feedback will lead to the flaws being fixed. We've got to start somewhere.
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Jonathan Edwards
Senior Member (Voting Rights)
But is it?
My impression is that data so far suggest that five people and maybe a dog have done it.
I find it hard to believe that this sort of module is used for teaching on al diseases? If I had to work through this sort of thing for every disease that was going to come along I would resign from being a GP or physician and go and run a cake shop or something sane.
This sort of exercise is utterly repelling. But a department seminar or a review in BMJ or Pulse that I could read when I had a quiet moment could be really interesting and change my view.
I don't see these modules as changing anyone's view because the material is presented as pseudo-medicine. It is quite clearly put together by someone who has no real idea of what the terms mean or why they are useful. People with ME/CFS have got used to this sort of pseudo-medicine as if it was the norm. It never used to be and I doubt it is even now for other diseases.
And, as I have said before, I think there is a major danger that this sort of material will just wise up the health professionals to how much ME/CFS services are just window dressing by people who don't know what they are doing. And people with ME/CFS will be assumed all to have a pseudo-illness that has to be treated with politically correct lip service according to the module but otherwise ignored as much as possible.
The more I think about it the more it seems to me that the problems for looking after people with severe ME/CFS are near enough unique. Health care professionals need to be told "Forget all your usual wasy of thinking about disease. Be a human being for a minute and look at this quite differently". No jargon. No pretend explanations.
Elara Grey
Established Member (Voting Rights)
Precisely my point actually about reforming the entire system. I wouldn't hesitate in hazarding a guess that the majority of NHS doctors are thinking similar thoughts to your description about resigning. The same goes for nurses. And they wouldn't be the first to quit to do something else for similar reasons. (Though not just the state of the eLearning).
Can't comment specifically on all diseases because generally-speaking, AFAIK, NHS e-learning isn't designed to teach physicians about diseases... otherwise what would the point of medical school be? /rhetorical
But yes, almost all NHS e-learning is repelling, or at least more repelling than this module is.
It might be worth considering that NHS e-learning is generally targeted to the whole of the NHS as its audience? With the exception of some specific modules being designated for specific roles or leadership roles in various forms. I get the impression that any NHS e-learning modules on specific diseases/or illness are nothing more than awareness modules. That's how I see the ME/CFS ones presented.
We are in agreement.
I suppose I just saw the module as an awareness module targeted to all members and roles of the NHS. And, to be quite frank, I never had any expectations that an NHS module would achieve changing anyone's view. So my opinions were formed off a very low bar to start with.
And yes, exactly this!
I just don't see anyone writing an NHS e-learning module actually putting those kind of statements to their name. Or the NHS agreeing to put such sentiments to their 'branding'. At least, not at this moment in time.
Those statements coming from the NHS would be the same as admitting a) we don't know anything about ME/CFS, and b) they need to overhaul what they are doing. Akin to admitting they are doing something wrong. And the system as it stands does not seem to do that. It seems protects itself at all costs.
So the only way I see something being produced by the NHS that has the aim of changing anyone's view completely is when research has caught up and there is tangible evidence of disease and/or a biomarker.
Yes, the pseudo-medicine is not going to help any of us. Yes, it is far from being an enthralling, mind-changing learning module. My previous comments were about it being mostly positive FOR THE NHS. Starting from a very low bar. Against the standard of their other e-learning modules, this is better than what they usually produce. But that's not to say it's all that productive in terms of what we actually need!
I guess I just never had any expectations of it being exceptionally revolutionary to begin with. Especially in its first (or slightly amended) creation. And I see the module as an awareness module for all levels of the NHS e.g. domiciliary carers looking after people with severe ME/CFS.
I doubt any e-learning module, with or without NHS logo attached, would achieve education about a disease that would completely swing physicians' views. As you rightly say, that would take something aimed at physicians, from a respected source. I'd add more importantly from inclusion in medical education. No e-learning module is going to compensate for the general lack of its inclusion in the latter.
As above, I'm not trying to defend the e-learning in its current version or argue that it's good. I completely agree with the numerous valid points and criticisms against it. And I'm on the same page that this kind of structure of e-learning is utterly repelling. Therein lies my point as to why the NHS uptake on it has been next to nothing.
Jonathan Edwards
Senior Member (Voting Rights)
But isn't this the central point? Charity representatives have been lobbying the Royal College of Physicians to ensure that all medics do this e-learning module. That seems to be the way doctors are supposed to learn about severe ME/CFS. Why would cancer and diabetes be under medical school textbooks and severe ME/CFS instead put in with fire drill, data protection and equal opportunities?
The RCP probably said yes, we will get everyone to do it, yet at the same time the RCP experts on ME/CFS think it is all make believe, physicians should steer well clear of it and starving patients will get better with psychological support.
The whole thing seems to be a fiasco.
My worry is that people will see this as having achieved something when in fact it has ensured that nobody confronts the health professional education issue at all.
Elara Grey
Established Member (Voting Rights)
Oh dear. I didn't realise the charities were lobbying the RCP.
Indeed.
Quite!
The entire situation is a mess.
Some posts have been moved to a new members only thread:
Fact sheet #4 - Management of severe and very severe ME/CFS - discussion
Fact sheet #4 - Management of severe and very severe ME/CFS - discussion
Chandelier
Senior Member (Voting Rights)
NHS England's ME/CFS e-Learning Modules FOI Results reveal lack of uptake - The ME Association
FOI results reveal low uptake of NHS England's ME/CFS e-learning modules. Read the findings and the ME Association's comments
meassociation.org.uk
FOI results summarised by Lucibee
hotblack
Senior Member (Voting Rights)
It feels like the e-learning modules have been mentioned in parliament or in response to written questions about what the government is doing more times than they’ve been read.
Remember when the Royal College of Physicians told the DHSC they were going to aim to have all their members take them by the end of 2025? (Two sources here and here)
Remember when the Royal College of Physicians told the DHSC they were going to aim to have all their members take them by the end of 2025? (Two sources here and here)
hotblack
Senior Member (Voting Rights)
I do think this an opportunity to flag to DHSC that change isn’t just going to magically happen by asking nicely and that assurances given are worthless.
Education is of course vital as is research investment. But we need legislation or some other form of concerted effort or nothing is going to change. Unless people are held responsible for their actions we are going to continue to suffer. Inaction is itself a choice and that has associated responsibility too. Choose not to act and politicians make themselves responsible too. This has gone on for too long and people are continuing to needlessly suffer and face medical neglect and poor outcomes.
I’m sure there’s plenty of people who are not deeply anti people wih me/cfs. I’ve said before I think ignorance is the primary problem. But the systemic culture is to ignore us and it is not being challenged nearly strongly enough.
Education is of course vital as is research investment. But we need legislation or some other form of concerted effort or nothing is going to change. Unless people are held responsible for their actions we are going to continue to suffer. Inaction is itself a choice and that has associated responsibility too. Choose not to act and politicians make themselves responsible too. This has gone on for too long and people are continuing to needlessly suffer and face medical neglect and poor outcomes.
I’m sure there’s plenty of people who are not deeply anti people wih me/cfs. I’ve said before I think ignorance is the primary problem. But the systemic culture is to ignore us and it is not being challenged nearly strongly enough.
BrightCandle
Senior Member (Voting Rights)
Until mandatory measures are taken no progress will be made. Be that in education of medical students and in the wider medical communities. If its optional it will be ignored and given the sheer numbers of ME/CFS patients being abused by medicine currently its unacceptable for this to continue.
I've taken part in the marking of the medical essays in the medical students competition over the past 2 years.
Undertaking a CPD module is required to demonstrate knowledge in the essay itself, and whilst the standard has risen , there is a clear difference in understanding and response from those who have some awareness of the ME/CFS previously, be it family / friend/ friend's family and those who are new to the condition. ( and also those using AI to try and game the prize)
There's still a lot to do.
Chandelier
Senior Member (Voting Rights)
Lou B Lou
Senior Member (Voting Rights)
So unless the e-learning modules are Compulsory they will not be widely read. At present they are barely read.
hotblack
Senior Member (Voting Rights)
Exactly. It’s a systemic problem and needs to be treated as such. The system is not taking the problem seriously so why would people within it? The system is of course built by people so it’s somewhat circular, but it also means if we can get a few people to take the issues seriously then the system can be changed and that has an outsized effect. This and that I think ignorance is the problem rather than strong held beliefs is why in a way I am positive we can effect substantial change, there’s possibility for a sort of cascading snowball effect. The problem is getting that first bit going. Otherwise indifference wins, it is a powerful and easy for people.
We need a big, visible, loud voice making this a priority. If someone would make a compelling tv series about us like the post office scandal had that would get public attention. Or a big popular public figure on our side telling the story again and again and again. Charity campaigns will never cut it or reach new audiences, they are primarily fundraising not awareness or change.
Within the medical community having clear mandatory training, proper classification and a specialism or department to have responsibility would help as we’ve discussed. We need that education but also ownership and responsibility within the system. Obviously having tests or treatments would, but other conditions without manage better than us. That could come through senior medical professionals but they are a funny lot, they often don’t seem to listen to each other and certainly not outsiders and hate being told what to do. While they often think politicians are not as clever as them I think it will take political will to see this as the scandal it is and act, knowing there may be an initial fight or pushback.
Right now medical and political will is just not there to admit there is a problem, take responsibility and make he changes needed. That is what we need to somehow change to start the ball rolling. Maybe demonstrating that the current soft and half hearted approach with a bit of guidance and an optional e-learning module and accepting assurances from the RCP is failing will help. We need drive and action, people willing to try to push change through.
We need a big, visible, loud voice making this a priority. If someone would make a compelling tv series about us like the post office scandal had that would get public attention. Or a big popular public figure on our side telling the story again and again and again. Charity campaigns will never cut it or reach new audiences, they are primarily fundraising not awareness or change.
Within the medical community having clear mandatory training, proper classification and a specialism or department to have responsibility would help as we’ve discussed. We need that education but also ownership and responsibility within the system. Obviously having tests or treatments would, but other conditions without manage better than us. That could come through senior medical professionals but they are a funny lot, they often don’t seem to listen to each other and certainly not outsiders and hate being told what to do. While they often think politicians are not as clever as them I think it will take political will to see this as the scandal it is and act, knowing there may be an initial fight or pushback.
Right now medical and political will is just not there to admit there is a problem, take responsibility and make he changes needed. That is what we need to somehow change to start the ball rolling. Maybe demonstrating that the current soft and half hearted approach with a bit of guidance and an optional e-learning module and accepting assurances from the RCP is failing will help. We need drive and action, people willing to try to push change through.
Elara Grey
Established Member (Voting Rights)
This NHS doctor's comments are pretty much what I was trying to say, too.
And whilst making them mandatory might bring about more engagement, it is unlikely to help.
It would simply become an exercise of clicking through as fast as possible whilst otherwise occupied, in order to get the completion certificate and tick it off the list. (Which is likely why they're designed the way they are - so that people have to actually look at the screens to click.) With a list of mandatory training that already takes a week's worth of working hours to complete, with next to no allocated time... noone is going to be interested or care about the contents even if they did complete it.
It brings us full-circle. The creation of eLearning modules being cited as progress within political answers is nothing more than a tick box exercise in itself.
It was entirely predictable given the state of mandatory eLearning that the uptake of additional modules would be next to nothing. But I doubt any MPs had to spend a whole first induction week doing eLearning about nothing and everything at the same time, after they got elected... who knows, maybe they really do think it is progress. It would take quite some ignorance though as the majority of said mandatory eLearning appears to be attempting to put a band aid on systemic problems.
Something gone wrong? Perfect solution: a mandatory eLearning module so we can pretend that's taking accountability without changing anything. Lessons were learned. Check.
IMO, significant change within the system will have to come from elsewhere before the eLearning modules ever achieve anything. Even if they were the most perfect and well-designed modules possible.
When the NHS offers a good work-life balance, offers a supportive, healthy and happy work environment, and isn't on the brink of collapse whilst being held up by the individual frontline staff doing the workload of 3 people... then, and only then, might eLearning make a difference. That's once they have reversed the current culture towards eLearning. And reduced it down to a tenth of what it is.
But I suspect that if the NHS managed to cultivate such a working environment, that alone would solve a lot of problems. In turn, reducing the need for eLearning modules... shrug.
I don't have the energy, but if I did, I'd put a FOI in for a full list of all mandatory eLearning with estimated completion times and required frequency of completion. For various different roles within the NHS. And the full list of eLearning modules available, or perhaps just the full number of modules available.
Then I'd forward to the charities, anyone involved in the APPG, and MPs.
And ask their thoughts on the likelihood of them finding the time for an additional few modules in a condition they had either never heard of or didn't think was necessary to know about, if they were in the position of being required to do that much eLearning.
While I was at it, I'd have a go at asking their thoughts on the appropriateness of a condition that can be so debilitating and life-threatening being whittled down into eLearning amongst pearls of wisdom such as:
- which fire extinguishers to use, but also don't use a fire extinguisher if it's dangerous and call 999
- how to not overload electrical sockets,
- which colour mop to use where and when,
- data protection,
- site safety like not letting unauthorised individuals tailgate through access points,
- how to store records,
- how to use the electronic records systems,
- financial governance, and
- that you must leave wet floor signs out and remove tripping hazards so people don't fall...
Yes, progress to have the eLearning. But when it is also the forced method of transferring endless 'knowledge' about nothing, it's hard to make it not get lost in that, at best. Worse, trying to get someone to spend their own time, often unpaid, to go looking for another sliver of such 'wisdom' will get nothing more than an eye roll.
Probably even if you put the winning lottery numbers in a NHS eLearning module and shouted about it on the rooftops, you'd get as much uptake as the ME/CFS modules have had.
Outside of medicine online training is given normally by HR to cover the organisations backside/liability that it wasn’t that the employee didn’t know the right way/that x wasn’t ok and here’s an example of it. So that eg if anyone then went on to blatantly discriminate in an interview process or bully someone then the employee can’t claim they didn’t know what was appropriate and expected. And makes it more possible for them to put them thru due process if they do wrong.
That’s why the ticking each section matters with a click thru too. Because the employee is confirming they read that short para or diagram - if they chose not to and click as if they had then that also says something about the employee.
MrMagoo
Senior Member (Voting Rights)
I have some sympathy with NHS staff because they are basically expected to do mandatory training in their own time, it’s so hard to get time “off” or “protected” from the day to day to attend courses, years ago it was very different.
So no, voluntary e-learning is a non-starter.
So no, voluntary e-learning is a non-starter.