Using a Digital Story Format

A Contemporary Approach to Meeting the Workforce Needs of Public Health Laboratories

Abstract

Introduction: 

Public health laboratories are an integral partner in preparedness and emergency response. The Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC)^* and the State Hygienic Laboratory at the University of Iowa have a long history of working together to identify and meet the preparedness training needs of the laboratory workforce. The training, Anatomy of a Foodborne Outbreak, which uses a digital story format, provides an example of this partnership.

Background/Rationale: 

The State Hygienic Laboratory expressed the need for training programs targeted at enhancing early detection and investigation of outbreaks. Clinical laboratory staff play a significant role in identifying patient samples that may represent the effects of foodborne illness. Given that foodborne illnesses are on the increase nationally, it is critical that laboratory staff be prepared to deal with these outbreaks.

Methods/Activity: 

UMPERLC collaborated with State Hygienic Laboratory content experts in the design and development of a digital story, using a foodborne outbreak that focuses on testing to detect Shiga toxin–producing Escherichia coli. This narrative format was selected because seeing and hearing a story about the training content provide the learner with a deeper interaction and richer learning experience, allowing the learner to better see the bigger picture.

Results/Outcomes: 

Anatomy of a Foodborne Outbreak is available on UMPERLC's Learning Management System, Training Source (http://training-source.org). Evaluation data indicate positive learning experiences overall.

Discussion: 

The digital story format, which is a video that uses a blend of images, text, and audio narration, was an appropriate method for the content and learning outcomes of the Anatomy of a Foodborne Outbreak training. This format requires more active learning, which increases retention and transfer of knowledge. Training that is easily accessed and user-friendly is an important resource for laboratory staff.

Lessons Learned/Next Steps: 

When reviewing the course completion data, the highest enrollment occurred immediately after the training program was released. To increase visibility, Anatomy of a Foodborne Outbreak is housed on both the State Hygienic Laboratory Web site and UMPERLC's Learning Management System. The course has also been added to national learning databases such as the Centers for Disease Control and Prevention TrainingFinder Real-time Affiliate Integrated Network (CDC TRAIN) and Certified in Public Health Recertification & Reporting System.

In Brief

This article describes the effectiveness of using a digital story format as an innovative approach to preparedness training for the public health laboratory workforce.

State public health laboratories are critical partners in preparedness and emergency response. Like the rest of the public health system, the laboratory workforce is operating under the pressures of reduced budgets, a scaled-back workforce, and limited funding for training and education. Yet, they must be ready to provide surge capacity for testing when an event, such as an outbreak, occurs.

The State Hygienic Laboratory at the University of Iowa faces many such challenges. Serving all 99 of Iowa's counties, it provides services such as disease detection, environmental monitoring, and newborn and maternal screening. It has been a key partner of the Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC), located at the University of Iowa College of Public Health, since its initial funding in 2001. The 2 partners have collaborated on many training programs over the years. The most recent collaboration involved the development of the online training program, Anatomy of a Foodborne Outbreak.

To help partners meet the challenges they face in providing training education, UMPERLC primarily uses distance education technologies. Online learning addresses many of the problems posed by the limited time and financial resources allocated for training and workforce development. UMPERLC also uses new methods to more effectively deliver content online. These methods, including the digital story format that was used to develop Anatomy of a Foodborne Outbreak, more actively engage learners to increase the transfer of knowledge.

Background/Rationale

On a national level, data reveal that the incidence of foodborne illnesses has increased. A snapshot report released in October 2012 by the US Public Interest Research Group indicates that the number of Americans with foodborne illnesses increased by 44% between 2011 and just the first 9 months of 2012.¹ The State Hygienic Laboratory conducts an average of 2000 tests per year related to Shiga toxin–producing Escherichia coli (STEC). The usual cause is contaminated food.

The State Hygienic Laboratory expressed the need for training programs targeted at enhancing early detection and investigation of outbreaks. Clinical laboratory staff working in microbiology play a significant role in identifying patient samples that may represent the effects of foodborne illness. These same laboratory scientists may not be aware of the time that is also required at the state laboratory to finalize testing, identify an outbreak, and pull tainted food from shelves. Since the contaminated product must be identified and removed from the food supply to prevent further infection, it is crucial that laboratory staff be fully prepared to deal with foodborne outbreaks.

Methods/Activity

UMPERLC collaborated with State Hygienic Laboratory content experts in the design and development of the digital story, using a foodborne outbreak that focuses on testing in the clinical laboratory to detect STEC. UMPERLC selected this narrative format because seeing and hearing a story about the training content provide the learner with a deeper interaction and richer learning experience, allowing him or her to better see the bigger picture. The digital story, Anatomy of a Foodborne Outbreak, is a video that uses a blend of images, text, and audio narration to present the story of a foodborne outbreak.²

Anatomy of a Foodborne Outbreak, addresses 3 learning objectives that were identified in the planning process: (1) recognize the overall community and public health significance of an enteric pathogen from just one patient; (2) understand the process and timeline of a foodborne outbreak; and (3) describe the role of sentinel laboratories in preventing the spread of illness caused by contaminated food. The course content consists of 2 main components: a digital story of an E coli O157:H7 outbreak and a training session.

The digital story contains audio and visual components to present the story of an outbreak caused by contaminated lettuce. The narrative illustrates the overall community and public health significance of an enteric pathogen and shows the process and timeline for identifying and mitigating a foodborne outbreak.

A narrator tells the story, which focuses primarily on the experiences of 2 hypothetical patients whose stool specimens are collected and sent to 2 laboratories that use slightly different procedures. Although both test for and identify STEC, only laboratory 1 reports its finding to the public health department. The narrative later reveals that if laboratory 2 had also contacted the public health department, the source of the outbreak could have been identified by day 7 rather than day 20.

After viewing the digital story video, the user moves onto the training session, which is broken down into 6 sections: (1) Centers for Disease Control and Prevention's Recommendations; (2) Available Methods—Toxin Testing and Culture; (3) Reporting Toxin and Culture Results; (4) Submission of Isolates to the Public Health Laboratory; (5) Iowa-Specific Recommendations/Iowa Administrative Code; and (6) Checklists. The first 4 sections present the user with information and then ask him or her to respond to several short questions based on the material. The fifth section, Iowa Recommendation, is designed either for laboratories in Iowa or for laboratorians who provide testing on specimens from patients in Iowa. Checklists can be viewed at any point during and after the training; they may be particularly useful during testing or after the identification of a patient positive for Shiga toxin or an isolate of STEC. These tools help provide the best patient care and meet the public health requirements to detect and stop outbreaks. While the training is primarily geared toward laboratory staff, the digital story makes clear the importance of communication between laboratories and local, state, and federal public health agencies.

Results/Outcomes

Anatomy of a Foodborne Outbreak is available on UMPERLC's Learning Management System, Training Source (http://training-source.org). Since its release in 2012, a total of 124 users have completed the training. In reviewing the evaluation data, 95% of users reported that they were satisfied with the course overall; 95% thought that the course enhanced their knowledge of the subject; and 74% considered the course relevant to what they might expect to do to prevent, prepare for, or respond to an emergency. In addition, 71% thought that the course was relevant to their daily job and 95% would recommend it to others.

In reviewing qualitative data from the course, the following themes emerged: (1) the training reinforced/refreshed known practices; (2) the digital story, including the timeline of a foodborne illness, contributed to learning; (3) some users experienced technological difficulties; and (4) the training was very informative and provided further knowledge of the subject area.

Discussion

The digital story format, a video that uses a blend of images, text, and audio narration, is an appropriate method for the content and learning outcomes of the Anatomy of a Foodborne Outbreak training. Because this format requires more active learning, it increases retention and transfer of knowledge. Learners become more engaged as they move beyond just watching or reading information presented. To progress through the training, they must respond to questions using the knowledge they have gained.

Because events such as major outbreaks are not a daily occurrence, having a training program that is easily accessed and user-friendly is an important resource for laboratory staff. In addition, since the training is online and available at no cost, it addresses other common barriers (time and budget constraints). Finally, the course aligns with the Public Health Preparedness and Response Core Competency Model as well as the Public Health Preparedness Capabilities. Specifically, it addresses Competency Domain 1 (Model Leadership), Competency 1.1 Solve problems under emergency conditions, and Capabilities 12 and 13 (Public Health Laboratory Testing, Public Health Surveillance and Epidemiological Investigation).³

Lesson Learned/Next Steps

When reviewing the course completion data, the highest enrollment occurred immediately after the training program was released. To increase visibility, Anatomy of a Foodborne Outbreak is housed on both the State Hygienic Laboratory Web site and UMPERLC's Learning Management System. The course has also been added to national learning databases such as the Centers for Disease Control and Prevention TrainingFinder Real-time Affiliate Integrated Network (CDC TRAIN) and Certified in Public Health Recertification & Reporting System. UMPERLC continues to market the training through partner organizations, various Web sites, electronic newsletters, and social media.

Learners indicate that the digital story format is an effective training method to convey important information on responding to foodborne outbreaks. UMPERLC will continue to use digital stories as it develops future training programs. The ability to access training programs anytime, anywhere, and in a user-friendly format supports the public health workforce as it carries out its mission, which includes emergency preparedness and response.